title: Pumactant and poractant alfa for treatment of respiratory distress syndrome in neonates born at 25-29 weeks' gestation: a randomised trial.
abstract: BACKGROUND
  Exogenous surfactant preparations vary in their constitution and biophysical properties. Synthetic and animal-derived preparations lower the rate of death compared with controls. No significant differences in mortality or important long-term clinical outcomes have been shown between them in randomised trials. We did a randomised controlled trial to compare pumactant, a synthetic surfactant, with poractant alfa, an animal-derived surfactant, both of which are widely used in the UK.
  
  
  METHODS
  We enrolled 212 neonates born between 25 weeks' and 29 weeks and 6 days' gestation who were intubated for presumed surfactant deficiency and were free from life-threatening malformations. We randomly assigned 105 neonates poractant alfa, and 107 pumactant. The primary outcome was duration of high-dependency care and mortality was a secondary outcome. Analysis was by intention to treat.
  
  
  RESULTS
  Outcome data were analysed for 199 babies. The trial was stopped on the recommendation of the data and safety monitoring committee because mortality assumed a greater importance than the primary outcome. Predischarge mortality differed significantly between groups, in favour of poractant alfa (14.1 vs 31.0%, p=0.006; odds ratio 0.37 [95% CI 0.18-0.76). This difference was sustained after adjustment for centre, gestation, birthweight, sex, plurality, and use of antenatal steroids.
  
  
  CONCLUSIONS
  Mortality was unexpectedly lower among neonates who received poractant alfa than among those who received pumactant, and was independent of all the variables we investigated. Stopping the trial early may have widened the difference between the treatment groups.
authors.affiliation: Newcastle Neonatal Service, Royal Victoria Infirmary, Newcastle upon Tyne, UK.
authors.forename: S B
authors.initials: SB
authors.lastname: Ainsworth
authors.forename: M W
authors.initials: MW
authors.lastname: Beresford
authors.forename: D W
authors.initials: DW
authors.lastname: Milligan
authors.forename: N J
authors.initials: NJ
authors.lastname: Shaw
authors.forename: J N
authors.initials: JN
authors.lastname: Matthews
authors.forename: A C
authors.initials: AC
authors.lastname: Fenton
authors.forename: M P
authors.initials: MP
authors.lastname: Ward Platt
mesh_terms: D002423:Cause of Death; D005260:Female; D005865:Gestational Age; D017052:Hospital Mortality; D006801:Humans; D007226:Infant Mortality; D007231:Infant, Newborn; D007902:Length of Stay / Q000706:statistics & numerical data; D016015:Logistic Models; D008297:Male; D016017:Odds Ratio; D011663:Pulmonary Surfactants / Q000145:classification / Q000627:therapeutic use*; D012128:Respiratory Distress Syndrome / Q000150:complications / Q000188:drug therapy* / Q000401:mortality; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D011663:Pulmonary Surfactants