Background: Etiological treatment of respiratory distress syndrome due to lung immaturity with exogenous surfactant is of proven efficacy. However, it is not clear whether all the exogenous surfactants available, both natural and synthetic, are of equal efficacy.
Objective: To evaluate whether there is any evidence to support the efficacy of one exogenous surfactant over that of the others in the prophylaxis and treatment of respiratory distress syndrome.
Methods: To identify all the comparative studies of tensoactive compounds, an intensive bibliographic search was performed in several databases.
Results: Data was found to corroborate that natural surfactants improve oxygenation more rapidly than synthetic surfactants. Natural surfactants also have lower complication and mortality rates. Of the two natural surfactants available in Spain, the porcine-derived surfactant (poractant-alfa) seems to present some advantages over the bovine-derived surfactant (beractant), such as faster action, expressed as a more favourable PaO2/PAO2 ratio during the first 24 hours of treatment. There is also a trend indicating that newborns treated with porcine surfactant have a lower overall mortality rate (3 %) compared with those treated with bovine surfactant (12.5 %).
Conclusion: No scientific evidence supports the current use of commercialised synthetic surfactants. The porcine-derived surfactant can be considered as the preparation of choice, although additional studies confirming this finding would be useful.