Dear Colleagues!!!

Please, share with me your experience with Infasurf as surfactant replacement therapy in RDS. Still now, we are using Curosurf for this purpose. Probabaly, some of you used both these surfactants. I would like know to what is better as medicine of choice.

Leonid

There are no direct comparative studies between these 2 surfactants. In a retrospective study, better survival and less cost were assciated with Curosurf use than with infasurf. Also, composition of curosurf is different than infasurf. Curosurf contains the highest amount of phospholipids (higher than Infasurf) and highest amout of anti-oxidant phospholipids, plamalogens. Alveofact, which is prepared very simialr to Infasurf contains very little plasmalogens. Furthermore, 4 large randomized controlled trials comparing infasurf with survanta have shown no differences in mortality, BPD, or dosing requirements. However, 4 studies comparing curosurf with survanta has shown better survival, less dosing, faster weaning, and cost effectiveness in favor of curosurf. We have used exosurf, survanat, infasurf and curosurf. Based on the published studies, we switched to curosurf and we have been very pleased with using Curosurf in our NICUs.

Dear Dr.Ram,

thanks a lot for useful information and comparison of different surfactant medications. We use Curosurf also. My field of interesting is surfactant replacament therapy, therefore I paid my attention about few articles about Infasurf, but a lot of about Survanta, Curosurf. May be nobody don't use Infasurf due to insufficient of SP-B,SP-C concentration and phospholipid fraction or any other clinical reasons.

As we review current surfactant practices I am confused by some of the statements above and would like further input. My understanding is that SP-B is essential for surfactant function but as a weight:weight ratio of phospholipids as demonstrated in Seeger et al in 1993. Also, I inderstand that plasmologens reduce viscosity but have never been shown to reduce BPD, in fact plasmologens have only been seen in BAL specimens of those infants without BPD. And from all my literature search, other than retrospective analysis that are of epidemiologic nature, no surfactant has been shown to be superior when it comes to mortality or morbidity, but only those surfactants rich in SP-B show a rapid and short term benefit until the infant can produce their own endogenous surfactant. It is my understanding that Infasurf has a SP-B:Phospholipid concentration of 0.74% while Curosurf is only 0.59%. Please elaborate more on literature with greater n numbers and smaller babies to help me see the advantages and disadvantages.