NATURAL OR ARTIFICIAL SURFACTANT - ARGUME NTS IN FAVOR OF THE PREFERENTIAL USE OF NATURAL SURFACTANT

The use of exogenous surfactant (ES) is an essential component for pre vention and treatment of hyaline membrane disease (HMD). The ES availa ble for clinical use are of two therapeutic classes: natural surfactan ts prepared from mammalian lung and artificial surfactants. The choice between these two classes of ES is controversial. In this overview, w e present the arguments in favour of the preferential use of natural E S. The presence of hydrophobic specific proteins (SP-B and SP-C) provi des to natural ES better surface tension properties than artificial ES . The in vitro greater efficacy of natural ES has been confirmed in vi vo in experimental models of surfactant deficiency, human pharmacodyna mic studies, and comparative clinical trials. Furthermore, the excelle nt clinical tolerance and harmlessness of natural ES has been firmly e stablished. A meta-analysis of the comparative clincial clinical trial s between natural ES and one artificial ES (enrolling as many as 4400 babies treated for HMD) suggests that the use of natural ES compared t o this artificial ES significantly reduces the neonatal mortality by 2 0%. In conclusion, all these arguments are in favor of the preferentia l use of natural ES for prevention and treatment of HMD.