Comparison of bovine vs porcine surfactants by less invasive surfactant administration technique (LISA) for preterm infants ≤ 30 weeks with respiratory distress syndrome (RDS): a randomized controlled trial

Respiratory distress syndrome (RDS) is the main cause of respiratory failure in preterm infants and its incidence differs depending on gestational age and birth weight. The best approach to treat RDS is the administration of delivery room CPAP followed by early selective surfactant administration for infants with worsening oxygenation and increasing work of breathing. European and American guidelines advise in favor of this strategy, which reduces mortality and bronchopulmonary dysplasia. Commonly available and widely used surfactants in India are Survanta/Beractant (bovine minced lung extract), Neosurf/BLES (bovine lung lavage surfactant), and Curosurf/Poractant alfa (porcine minced lung extract). A comparison of animal derived surfactants proved porcine surfactants to be superior over bovine surfactants in terms of efficacy and safety (Tridente et al 2019 systematic review). But this effect has not been well established with the current preferred method of surfactant administration i.e. LISA (less invasive surfactant administration) using a thin stiff catheter. All the previous studies where the LISA method was studied used porcine surfactant (poractant alfa/curosurf) for surfactant administration and bovine surfactants were not studied with this method. A recent study by Zamal et al has shown equivocal results with beractant when compared with poractant alfa by the LISA method and adverse events were not different between the two groups. However,  the study concluded with Beractant to be a better option in LMIC in terms of cost. Surfactant administration through LISA has adverse effects of surfactant reflux which is expected to be higher with bovine surfactants which are of high volume (survanta 4ml/kg , neosurf 5ml/kg) compared to porcine surfactant (curosurf 2.5 ml/kg). Cost associated is more with porcine surfactant compared to bovine surfactants. If more data is available with bovine surfactants with this new method, it would be practical to use bovine surfactants in LMICs where cost also plays an important role. So, we have taken up this study to compare efficacy & safety of bovine surfactants vs porcine surfactant by LISA method.