Catalogo Articoli (Spogli Riviste)

OPAC HELP

Titolo:
CONTROVERSIES - SYNTHETIC OR NATURAL SURFACTANT - THE CASE FOR NATURAL SURFACTANT
Autore:
HALLIDAY HL;
Indirizzi:
ROYAL MATERN HOSP,REG NEONATOL UNIT,GROSVENOR RD BELFAST BT12 6BB ANTRIM NORTH IRELAND QUEENS UNIV BELFAST,DEPT CHILD HLTH BELFAST BT12 6BB ANTRIM NORTH IRELAND
Titolo Testata:
Journal of perinatal medicine
fascicolo: 5, volume: 24, anno: 1996,
pagine: 417 - 426
SICI:
0300-5577(1996)24:5<417:C-SONS>2.0.ZU;2-4
Fonte:
ISI
Lingua:
ENG
Soggetto:
RESPIRATORY-DISTRESS SYNDROME; BLOOD-FLOW VELOCITY; ARTIFICIAL LUNG SURFACTANT; PRETERM LAMBS; REPLACEMENT THERAPY; INFANTS; RABBITS; TRIAL; BIRTH;
Keywords:
ANIMAL MODELS; COMPARATIVE TRIALS; NATURAL SURFACTANT; NEONATE; PHYSIOLOGICAL STUDIES; PRETERM; RESPIRATORY DISTRESS SYNDROME; SURFACTANT; SYNTHETIC SURFACTANT;
Tipo documento:
Article
Natura:
Periodico
Settore Disciplinare:
Science Citation Index Expanded
Science Citation Index Expanded
Citazioni:
53
Recensione:
Indirizzi per estratti:
Citazione:
H.L. Halliday, "CONTROVERSIES - SYNTHETIC OR NATURAL SURFACTANT - THE CASE FOR NATURAL SURFACTANT", Journal of perinatal medicine, 24(5), 1996, pp. 417-426

Abstract

Surfactant replacement therapy for respiratory distress syndrome (RDS) is not new, the first trials having been performed over 30 years ago. These early trials used synthetic protein-free surfactants administered as aerosols and were unsuccessful. Since 1980 a variety of naturaland synthetic surfactant preparations have been used to treat or prevent RDS, and both demonstrate clinical effects. I have used evidence derived from 3 areas to demonstrate the superiority of natural surfactants: in vitro physical properties, in vivo physiological effects and the results of comparative clinical trials. Using the pulsating bubble surfactometer, the surface tension at maximum and minimum bubble size are significantly lower for natural compared to synthetic surfactants (31 and 0 mN/m versus 53 and 29 mN/m respectively). Physiological effects of surfactants have been compared in immature rabbits and Iambs and both models demonstrate the superiority of natural surfactants. For example in immature rabbits lung complicance values after 60 minutes of ventilation are 0.60 ml/cmH(2)O in natural surfactant treated animals, 0.44 ml/cmH(2)O in synthetic surfactant treated animals and 0.34 ml/cmH(2)O in controls (p < 0.01). The technique of mete-analysis was used to analyse the outcome of 6 comparative clinical trials of natural and synthetic surfactants. These 6 studies included 3536 babies and 5 of them compared Survanta (a bovine natural surfactant) and Exosurf (asynthetic protein-free: surfactant). One study compared Infasurf (another bovine natural surfactant with Exosurf). Meta-analysis shows a 19% reduction in the odds of neonatal death for natural compared to synthetic surfactant heated babies (OR 0.81; 95% CI 0.66-0.98). For bronchopulmonary dysplasia there was a non-significant reduction in risk forSurvanta-treated babies (OR, 0.93; 95% CO 0.78-1.10). In summary, there is now clear evidence of physiological and clinical superiority of natural compared to synthetic surfactants. Surfactant proteins B and Care needed to facilitate rapid adsorption and spreading of phospholipids. They also account for the more rapid clinical action allowing oxygen and ventilator pressures to be lowered soon after administration. The odds of neonatal mortality are reduced by about 20% if natural surfactants are preferred to their synthetic protein-free counterparts. Long-term follow-up studies of babies treated with both types of surfactant should be a top priority.

ASDD Area Sistemi Dipartimentali e Documentali, Università di Bologna, Catalogo delle riviste ed altri periodici
Documento generato il 28/03/20 alle ore 23:21:01