Synthetic vs human surfactants in the treatment of respiratory distress syndrome: radiographic findings

Exosurf, a synthetic surfactant, was instilled endotracheally in 49 neonates as treatment for respiratory distress syndrome. The radiologic courses of these neonates were compared with the courses of 18 neonates previously treated with human surfactant and of 18 untreated neonates. The radiologic severity of respiratory distress syndrome decreased significantly in neonates treated with Exosurf compared with that in untreated neonates. Radiologic improvement in those treated with Exosurf was slightly delayed when compared with the improvement of age-matched neonates treated with human surfactant. Otherwise no significant difference was noted between Exosurf and human surfactant in radiologic severity of respiratory distress syndrome or in the prevalence of pulmonary interstitial emphysema, pneumothorax, and bronchopulmonary dysplasia. These findings support the thesis that artificial surfactant is an acceptable substitute for surfactants of biological origin, with possible benefits of safety and ease of use.