SynthesisRespiratory research2019
Porcine vs bovine surfactant therapy for preterm neonates with RDS: systematic review with biological plausibility and pragmatic meta-analysis of respiratory outcomes.
Synthesis in Respiratory research, 2019. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 17 papers, 4 of them syntheses that pooled it.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
17 citing papers in PubMed, 4 syntheses or guidelines pooled it, 54 citations in OpenAlex.
- Surfactant-Budesonide Combination to Prevent Death or Bronchopulmonary Dysplasia: A Systematic Review and Meta-Analysis.Neonatology · 2026Pooled it
- The Care of Preterm and Term Newborns with Respiratory Conditions: A Systematic Synthesis of Evidence from Low- and Middle-Income Countries.Neonatology · 2025Pooled it
- Association between Removal of High-Frequency Oscillations and the Effect of Epilepsy Surgery: A Meta-Analysis.Journal of neurological surgery. Part A, Central European neurosurgery · 2024Pooled it
- Porcine versus bovine surfactant therapy for RDS in preterm neonates: pragmatic meta-analysis and review of physiopathological plausibility of the effects on extra-pulmonary outcomes.Respiratory research · 2020Pooled it
- Comparison of efficacy between beractant and poractant alfa in respiratory distress syndrome among preterm infants (28-33Journal of perinatology : official journal of the California Perinatal Association · 2025Trial
- Less Invasive Surfactant Administration (LISA) versus Intubation Surfactant Extubation (InSurE) technique using higher volume surfactant in management of neonates with respiratory distress syndrome: an open-label randomized controlled trial.European journal of pediatrics · 2025Trial
- Bovine surfactant in the treatment of pneumonia-induced-neonatal acute respiratory distress syndrome (NARDS) in neonates beyond 34 weeks of gestation: a multicentre, randomized, assessor-blinded, placebo-controlled trial.European journal of pediatrics · 2021Trial
- Surfactant therapy in neonatal care: advances, challenges, and practical considerations.European journal of pediatrics · 2026Review
- Modulation of Pulmonary Fibrosis by Pulmonary Surfactant-Associated Phosphatidylethanolamine In Vitro and In Vivo.International journal of molecular sciences · 2025Article
- Transient tachypnoea: new concepts on the commonest neonatal respiratory disorder.European respiratory review : an official journal of the European Respiratory Society · 2025Review
- Comparative biophysical study of clinical surfactants using constrained drop surfactometry.American journal of physiology. Lung cellular and molecular physiology · 2024Article
- Respiratory distress syndrome in preterm infants of less than 32 weeks: What difference does giving 100 or 200 mg/kg of exogenous surfactant make?Pediatric pulmonology · 2022Article
- Comparative efficacy and safety of late surfactant preparations: a retrospective study.Journal of perinatology : official journal of the California Perinatal Association · 2021Article
- Towards homogenization of liquid plug distribution in reconstructed 3D upper airways of the preterm infant.Journal of biomechanics · 2021Article
- Surfactant therapies for pediatric and neonatal ARDS: ESPNIC expert consensus opinion for future research steps.Critical care (London, England) · 2021Article
- In vitro characterization and in vivo comparison of the pulmonary outcomes of Poractant alfa and Calsurf in ventilated preterm rabbits.PloS one · 2020Article
- Quantitative lung ultrasound to understand pathophysiology and guide surfactant therapy in neonates with meconium aspiration.Jornal de pediatriaArticle
Corrections and comments
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Authors and funding
3 authors at 3 institutions in 2 countries.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundBovine surfactants are known to be clinically equivalent but it is unclear if porcine or bovine surfactants at their licensed dose should be preferred to treat respiratory distress syndrome in preterm neonates.
methodsWe performed a comprehensive review of biochemical and pharmacological features of surfactants to understand the biological plausibility of any clinical effect. We then performed a pragmatic meta-analysis comparing internationally marketed porcine and bovine surfactants for mortality and respiratory outcomes. Search for randomised controlled trials with no language/year restrictions and excluding "grey" literature, unpublished or non-peer reviewed reports was conducted, following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and the most recent methodological recommendations.
resultsSixteen articles were included in the review and 14 in the meta-analysis (1491 neonates). 200 mg/kg poractant-α (a porcine surfactant) was associated with lower BPD/mortality (OR 0.632[95%CI:0.494, 0.809];p < 0.001),BPD (OR 0.688[95%CI:0.512, 0.925];p = 0.013), retreatment (OR 0.313[95%CI:0.187, 0.522];p < 0.0001), airleaks (OR 0.505[95%CI:0.308, 0.827];p = 0.006) and lung haemorrhage (OR 0.624[95%CI:0.388, 1];p = 0.051). Gestational age is associated with effect size for BPD (coefficient: 0.308 [95%CI:0.063, 0.554];p = 0.014) and surfactant retreatment (coefficient: -0.311 [95%CI:-0.595, - 0.028];p = 0.031).
conclusion200 mg/kg poractant-α is associated with better respiratory outcomes compared to bovine surfactants at their licensed dose. The effect of poractant-α on BPD and surfactant retreatment is greater at lowest and highest gestational ages, respectively.
trial registrationPROSPERO n.42017075251 .
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Registered trials
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