Authors

  1. Ihlenfeld, Janet T. PhD, RN

Article Content

LUCINACTANT REDUCES RDS AND BPD IN VERY LOW BIRTH WEIGHT INFANTS

Moya FR, Gadzinowski J, Bancalari E, Salinas V, Kopelman B, Bancalari A, Kornacka MK, Merritt TA, Segal R, Schaber CJ, Tsai H, Massaro J, d'Agostino R, for the International Surfaxin Collaborative Study Group. A multicenter, randomized, masked, comparison trial of lucinactant, colfosceril palmitate, and beractant for the prevention of respiratory distress syndrome among very preterm infants. Pediatrics. 2005;115:1018-1029.

 

Extremely low birth weight premature infants are predisposed to developing respiratory distress syndrome (RDS). In recent years, these infants have been treated with exogenous surfactants because deficiency in that product is what causes the RDS. Several medications have been developed as surfactant substitutes. This research sought to determine which of the more common surfactant products was better in reducing mortality as well as the development of bronchopulmonary dysplasia (BPD) in premature infants.

 

This study was conducted in 50 different level III intensive care nurseries in Europe and Latin America. The sample consisted of 1,294 premature infants with birth weights between 600 and 1,250 g and gestational ages of less than 32 weeks. The infants were randomly assigned to 1 of 3 different medication groups:

 

* Infants who received lucinactant (n = 527)

 

* Infants who received colfosceril (n = 509)

 

* Infants who received beractant (n = 258)

 

 

All of the infants had to be intubated after delivery and received their assigned medication roughly 27 minutes after delivery. In each case, the medication was administered via catheter to the tracheal space between the end of the endotracheal tube and the carina. The infants continued to receive positive pressure ventilation during the procedures. Infants were given more doses of their assigned surfactant only to maintain their respiratory status.

 

Findings showed that infants in the lucinactant group had less RDS at 24 hours of age (39.1%) than did those who received colfosceril. In addition, the lucinactant infants had a lower death rate than did both of the other groups by the end of 2 weeks. Results also note that these infants were also more likely to not suffer from BPD later in their hospital course.

 

The researchers noted that, overall, lucinactant was better in preventing RDS and BPD while increasing the chances of survival in very low birth weight infants. The researchers suggested that this was because of the chemical nature of lucinactant, which was more similar to natural surfactant than the other medications.

 

LUCINACTANT IS BETTER THAN PORACTANT ALFA IN PREVENTING BPD IN PREMATURE INFANTS

Sinha S, Lacaze-Masmonteil T, Valls i Soler A, Wiswell TE, Gadzinowski J, Hajdu J, Bernstein G, Sanchez-Luna M, Segal R, Schaber CJ, Massaro J, d'Agostino R, for the Surfaxin Therapy Against Respiratory Distress Syndrome Collaborative Group. A multicenter, randomized, controlled trial of lucinactant versus poractant alfa among very premature infants at high risk for respiratory distress syndrome. Pediatrics. 2005;115: 1030-1038.

 

Lucinactant was again investigated in a study comparing its efficacy against poractant alfa in very low birth weight premature infants. In this study, 252 infants 24 to 28 weeks of gestational age and with birth weight of 600 to 1,250 g were either given lucinactant or poractant alfa immediately after delivery. In this comparison, the aim was to determine whether the drugs reduced the incidence of bronchopulmonary dysplasia (BPD) in the sample.

 

The data showed that the infants in the lucinactant group were more likely to be free of BPD at 28 days of age when compared with those who received the poractant alfa medication. The rates of mortality were similar for the two groups.

 

The conclusion of this study was that lucinactant was more effective than poractant alfa in reducing the incidence of respiratory distress syndrome (RDS) in that population of infants. Considering that this study was undertaken in multiple hospitals in countries in Europe, the United States, and Canada, the findings support conclusions from other studies that lucinactant is highly effective in treating extremely low birth weight premature infants.