| Popis: |
Several exogenous surfactants are currently available and whilst controlled trials have demonstrated surfactant therapy is better than placebo, there are several unanswered questions that this thesis addresses through a review of existing evidence; 1. Which surfactant preparation is clinically more efficacious? 2. The choice between “rescue” (treatment after the development of RDS) or “prophylaxis” (prevention of RDS). 3. How many doses of surfactant are needed and what is the evidence for the size of the doses currently used? Four exogenous surfactant preparations - two synthetic and two animal-derived - have been licensed in the United Kingdom. The development of each surfactant is traced through a review of published trials. Current evidence from comparisons of synthetic and animal-derived surfactants is reviewed and THE evidence from comparative trials in neonates presented in an over-view using meta-analysis. This argument is further examined in a multi-centre randomised controlled trial looking at the effects of ALEC and Curosurf, the two most commonly used synthetic and animal-derived surfactants used in the UK. The trial was terminated early because of a significantly higher mortality in the ALEC arm. Results of the trial are discussed in relation to previous synthetic versus animal-derived surfactant trials. ALEC had been the most frequently used surfactant within the former Northern health region of England until publication of the study results and subsequent withdrawal of the ALEC by the manufacturer. The implications for neonatal service provision in the region in light of the results of the ALEC versus Curosurf trial are explored using data from the region. This functions as a geographic cohort and has developed a centralised model of neonatal intensive care provision through a collaborative consortium. |
