Comparison of three natural surfactants according to lung ultrasonography scores in newborns with respiratory distress syndrome

J Matern Fetal Neonatal Med. 2021 May;34(10):1634-1640. doi: 10.1080/14767058.2019.1643313. Epub 2019 Jul 24.


Introduction: Lung ultrasonography (LUS) is a noninvasive bed-side test and increasingly used by clinicians in the management and follow-up of respiratory distress syndrome (RDS) in premature infants.

Objective: To compare the results of three natural surfactants according to LUS scores in premature infants with RDS.

Methods: This was a prospective study on 62 preterm infants (25-34 weeks) with RDS and receiving surfactant according to 2016 European guidelines. All patients underwent a clinical evaluation and chest X-ray at three study points; at the first hours of life (presurfactant), and at 6-12th hour (early postsurfactant) and 24th hour (late postsurfactant) of surfactant. Simultaneously fractional inspired oxygen (FiO2) need, arterial PaO2 values, Downes and LUS scores were noted. The patients were randomized into three groups; Group 1 (n = 23), poractant alpha; Group 2 (n = 20), beractant; and Group 3 (n = 19), calfactant. The groups were compared according to clinical, laboratory and radiological variables as well as LUS scores.

Results: Gestational age (p = .05), birthweight (p = .07), and SNAPPE-II scores (p = .57) were similar in three groups. Repeated dose need was the highest in Group 3 (p = .04). FiO2 need (p = .04) was the highest and PaO2 values (p = .03) were the lowest at late postsurfactant point in the same group. LUS scores were also the highest in Group 3 at this period (p = .02). Downes scores were similar in groups at all points (p > .05). NICU stay were similar in groups (p = .53). The durations of total oxygen supplementation, mechanical ventilation, and hospital stay were the same in groups (p > .05).

Conclusions: In newborns with RDS, poractant alpha and beractant have similarly reduced oxygen need in accordance to the LUS findings. However, they seem to be superior compared to calfactant.

Keywords: Lung; distress; neonate; scoring; ultrasonography.

Publication types

  • Randomized Controlled Trial

MeSH terms

  • Humans
  • Infant
  • Infant, Newborn
  • Infant, Premature
  • Lung / diagnostic imaging
  • Prospective Studies
  • Respiratory Distress Syndrome, Newborn* / diagnostic imaging
  • Respiratory Distress Syndrome, Newborn* / drug therapy
  • Surface-Active Agents*
  • Ultrasonography


  • Surface-Active Agents