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Lung Treatments For Premature Babies Under Study

May 8, 2007
Medical College of Georgia
A pig-derived surfactant given to premature babies whose lungs aren't yet making the lubricant reduces mortality rates by 19 percent over two other commercially-available surfactants, researchers say.

Premature lungs don't immediately produce the essential lubricant, and air sacs are quickly damaged trying to function without it, even with ventilator support.
Credit: Image courtesy of Medical College of Georgia

A pig-derived surfactant  given to premature babies whose lungs aren’t yet making the lubricant reduces  mortality rates by 19 percent over two other commercially-available surfactants,  researchers say.

A retrospective study of 24,883  premature babies with respiratory distress syndrome treated in 191 U.S. hospitals from January 2003 to June 2006  showed reduced mortality for all causes in babies given poractant alfa,  according to lead researcher Dr. Jatinder Bhatia, chief of the Section of  Neonatology at the Medical College of Georgia in Augusta. “The differences hold true whether  you are sitting in a rural hospital or teaching hospital or non-teaching  hospital.”

The study was the first to compare  all three natural surfactants used in this country to treat babies with respiratory  distress syndrome. Previous studies, comparing poractant alfa with calf-derived  beractant, have yielded similar results; studies comparing beractant and  calfactant, also calf-derived, demonstrated no differences in mortality. The  smaller studies prompted researchers to do their more comprehensive review.

“We are looking at a large,  vulnerable population and we need this kind of data to make informed decisions,”  Dr. Bhatia says. He notes that the current analysis doesn’t explain differences  in mortality so additional studies might be needed.

   About 12.7 percent of babies are  born prematurely in the United States annually and about 30,000-40,000 babies  have respiratory distress with surfactant deficiency. “It’s inversely related to gestational  age and birth weight: the younger the baby, the higher the percentage of these  babies that have little or no surfactant,” says Dr. Bhatia.

Surfactant is a viscous, soapy-like substance that keeps thousands of air  sacs inside the lungs from sticking together when they inflate and deflate  while breathing.  “If you think of the  lungs as a million little balloons, these balloons collapse when the baby tries  to breathe out and that is why they get into respiratory distress,” says Dr.  Bhatia.

Premature lungs don’t immediately  produce the essential lubricant, and air sacs  are quickly damaged trying to function without  it, even with ventilator support.

Neonatologists try to prevent damage  by giving surfactant within the first hour after birth to tide the baby over  until his own lungs start producing it some 48 hours later, Dr. Bhatia says. Prescribed  surfactant will eventually become part of the baby’s endogenous pool. “We can give surfactant of a similar  composition as Mother Nature would have made to help ameliorate the disease  process. The basic premise is to give surfactant as early as possible to  prevent the baby’s lungs from collapsing. Once they collapse, it takes greater  support from the outside to reopen these units,” Dr. Bhatia says.

The surfactant effect is almost instantaneous. In fact, neonatologists are  increasingly taking babies off the ventilator at the same time surfactant is  given. Prenatal steroids, which accelerate lung maturity, are given to mothers  when premature birth is imminent. Lung-sparing measures, such as the lowest  possible ventilator setting, also are used.

Pig-derived poractant alfa, a relative newcomer approved by the FDA in 1999,  was the least-used surfactant in the study population. Of the 24,883 babies in  the data base provided by Charlotte, N.C.-based Premier Inc. 4,953 got  poractant alfa, marketed as Curosurf®; 12,653 got beractant marketed as  Survanta®; and 7,277 got calfactant, marketed as Infasurf®. Results are being presented May 7 during the Pediatric Academic  Societies Annual Meeting in Toronto.

Co-authors on the study included researchers at Women’s and Children’s  Hospital in Los Angeles and the University of  Oklahoma Health Sciences Center in Oklahoma City.

The study was funded by Dey,  L.P. and Chiesi Farmaceutici of Parma,   Italy, which  market and make poractant alfa. None of the researchers have financial  interests in either company. 

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Medical College of Georgia. "Lung Treatments For Premature Babies Under Study." ScienceDaily. ScienceDaily, 8 May 2007. <>.
Medical College of Georgia. (2007, May 8). Lung Treatments For Premature Babies Under Study. ScienceDaily. Retrieved May 26, 2017 from
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