Comparison of Porcine Versus Bovine Surfactant in preterm respiratory distress syndrome: Evidence from real world data. A multicenter collaboration from Karnataka

BACKGROUND & OBJECTIVES: Porcine surfactant (200 mg/kg initial dose) seems to be superior over bovine surfactants (100 mg/kg) in respiratory distress syndrome (RDS). There is limited data on choice of surfactant from the developing world. Logically using higher doses of porcine surfactant comes with additional burden of cost. We decided to evaluate the clinical effect of different types of surfactants. METHODS: A retrospective analysis was conducted from August 2019 to December 2022 in 6 tertiary centres. Neonates 24-34 weeks of gestation with RDS requiring either porcine (200 mg/kg) or bovine surfactant (100 mg/kg) were enrolled. The proportion of combined outcomes of death and or CLD, redosing and other morbidities in either group were analysed. The subgroup of preterm >28 weeks and outcomes between different surfactants were analysed. RESULTS: Out of 1149 eligible babies, 302 (26%) received surfactant after stabilisation with CPAP. 158 received porcine and 144 received bovine surfactant via INSURE technique. There was a higher combined outcome of death or CLD in porcine compared to the bovine group [48 (30%) vs 20 (13%), OR:2.7; 95% CI:1.5-4.8; p=0.001] and similar combined outcomes in >28 weeks sub-group. Redosing [27 (17%) Vs 18 (12%), OR:1.4; 95% CI:0.7-2.7; p=0.2] was similar. Other morbidities like air leak, invasive ventilation, CPAP duration were similar between both the groups and different types of surfactants. CONCLUSION: Porcine surfactant at 200mg/kg had similar combined outcomes of death/ CLD and redosing compared to bovine surfactant in preterm >28 weeks. Considering the cost burden in the developing world, the efficacy needs evaluation in randomised clinical trials.