PICOT Literature Review
Grand Canyon University
PICOT Literature Review
This literature review examines the available research on the topic of the administration of natural surfactant vs synthetic surfactant in neonates with respiratory distress syndrome. Respiratory distress syndrome is caused by a deficiency, dysfunction, or inactivation of pulmonary surfactant and is a significant cause of morbidity or mortality of preterm infants.
The literature reviewed, highlights the differences in extracted natural surfactants and synthetic surfactants and whether one proves to be more beneficial over the other.
Pfister RH, Soll R, Wiswell TE. ...view middle of the document...
In the randomized controlled trials conducted, the compared natural surfactant extract to synthetic surfactant demonstrated similar improvement in immediate need for ventilator support in infants who receive natural surfactant extracts. Although similar improvements were found, fewer deaths associated with natural surfactant extract treatment were found. With these findings the research lends to natural surfactant being a more desirable choice between the two. (Soll R, Blanco F., Cochrane Database of Systematic Reviews, Issue 2)
Seger N, Soll R. Animal derived surfactant extract for treatment of respiratory distress syndrome. Cochrane Database of Systematic Reviews, Issue 2. Art. No.: CD007836. DOI: 10.1002/14651858.CD007836.
In the above article natural (animal) derived surfactant is discussed regarding modified and unmodified surfactants. The modified natural derived surfactant is supplemented with phospholipids, whereas the unmodified natural derived surfactant only contains the remaining components after the extraction process. Thirteen randomized controlled trials demonstrated that both modified and unmodified natural derived surfactants showed a significant decrease in the risk of neonatal mortality. The findings of the trials lead to there being no differences in the outcomes of either being more significant than the other for the treatment of respiratory distress syndrome in premature neonates. (Seger N, Soll R., Cochrane Database of Systematic Reviews, Issue 2)
Pfister RH, Soll R, Wiswell TE. Protein containing synthetic surfactant versus animal derived surfactant extract for the prevention and treatment of respiratory distress syndrome. Cochrane Database of Systematic Reviews, Issue 4. Art. No.: CD006069. DOI: 10.1002/14651858.CD006069.pub3.
The above article discusses surfactants derived from bovine or porcine and non-protein containing synthetic surfactants. Both synthetic and animal derived surfactants have shown to be beneficial, however, the comparison of animal derived surfactant to non-protein containing synthetic surfactants have demonstrated improvement in immediate ventilator support and decreased risk of mortality in neonates receiving the animal derived products. It has been shown that the increased efficacy of animal derived surfactants might be due to the protein content. The evaluation of protein containing surfactant was reviewed. While there was a common efficacy in animal derived vs protein containing surfactant, there was insufficient evidence to justify choosing the animal derived over the synthetic for respiratory distress syndrome in neonates. Pfister RH, Soll R, Wiswell TE, Cochrane Database of Systematic Reviews, Issue 4)
Soll R. Synthetic surfactant for respiratory distress syndrome in preterm infants. Cochrane Database of Systematic Reviews, Issue 3. Art. No.: CD001149. DOI: 10.1002/14651858.CD001149.
In the above article the use of synthetic surfactant was discussed in the treatment of...