Infasurf Research Bibliography
1980 Metcalfe, IL et al
Pulmonary surfactant-associated proteins: their role in the expression of surface activity. Am Physio Soc. 1980:34-41.  
Summary: An extract of calf surfactant has equal biophysical and biologic activity to natural surfactant.
1983 Egan, EA et al
Natural and artificial lung surfactant replacement therapy in premature lambs. J Appl Physiol. 1983;55:875-883.  
Summary: Instillation of calf surfactant extract at birth induces near normal respiratory function in lambs.
1983 Smyth, JA et al
Hyaline membrane disease treated with bovine surfactant. Peds. 1983;71:913-917.  
Summary: Six preterm infants with severe RDS were treated with extract of calf surfactant showing improved arterial oxygenation lasting up to 24 hours.
1992 Cummings, JJ et al
A controlled clinical comparison of four different surfactant preparations in surfactant-deficient preterm lambs. Amer Rev Resp Dis. 1992;145:999-1004.  
Summary: Lambs with no endogenous surfactant had better and more sustained response with lower mortality following prophylaxis with Infasurf than with Exosurf or Survanta.
1992 Hall, SB et al
Importance of hydrophobic apoproteins as constituents of clinical exogenous surfactants.Am Rev Respir Dis. 1992;145:24-30.  
Summary: The increased concentration of hydrophobic surfactant apoproteins SP-B and SP-C in Infasurf explains its greater biophysical and biological activity compared to Exosurf and Survanta.
1993 Seeger, W et al
Surfactant inhibition by plasma proteins: differential sensitivity of various surfactant preparations. Eur Respir J. 1993;6:971-977.  
Summary: Infasurf is more potent and less vulnerable to inhibition than Survanta or Curosurf because of the high SP-B content.
1995 Mizuno, K et al
Surfactant protein-B supplementation improves in vitro function of a modified natural surfactant. Ped Research. 1995;37:271-276.  
Summary: SP-B level in Survanta is sub-threshold. Its low SP-B is the reason for less biologic activity than Infasurf.
2002 Notter, RH et al
Component-specific surface and physiological activity in bovine-derived lung surfactants. Chem Phys Lipids. 2002;114:21-34.  
Summary: Infasurf’s higher SP-B content is a crucial factor in surface activity and its ability to improve pulmonary mechanics.
2002 King, DM et al
Bulk shear viscosities of endogenous and exogenous lung surfactants. Am J Physiol Lung Cell Mol Physiol. 2002;282:L277-84.  
Summary: Infasurf and natural surfactant have lower viscosities at any given shear rate and concentration versus Survanta or Exosurf.
 
Infasurf Trials Bibliography
1985 Enhorning, G et al
Prevention of neonatal respiratory distress syndrome by tracheal instillation of surfactant: a randomized clinical trial. Peds. 1985;76:145-153.  
Summary: In a trial of 72 patients, 39 received a single dose of calf surfactant extract significantly improving gas exchange and reducing severity of RDS.
1985 Kwong, MS et al
Double blind clinical trial of calf lung surfactant extract for the prevention of hyaline membrane disease in extremely premature infants. Peds. 1985;76:585-592.  
Summary: Instillation of calf lung surfactant extract prior to the first breath in 27 patients showed a significant reduction of incidence of hyaline membrane disease 14% to 54% (P=0.033) versus control.
1991 Kendig, JW et al
A comparison of surfactant as immediate prophylaxis and as rescue therapy in newborns of less than 30 weeks gestation. N. Engl. J. Med. 1991;324:865-871.  
Summary: Calf lung surfactant extract was given at birth or hours after for newborns less than 30 weeks gestation. The newborns treated at birth had a higher survival, 88% to 80% (P=0.028), versus those treated only after RDS was present.
1993 Kattwinkel, J et al
Prophylactic administration of calf lung surfactant extract is more effective than early treatment of respiratory distress syndrome in neonates of 29 through 32 weeks gestation. Peds. 1993;92:90-98.  
Summary: The prophylaxis treatment of RDS produced less mortality, need for mechanical ventilation, oxygenation, re-dosing, and development of moderate RDS in the 1248 patients given calf lung surfactant extract.
1996 Hudak, ML et al
A multicenter randomized masked comparison of natural vs synthetic surfactant for the treatment of respiratory distress syndrome. Peds. 1996;128:396-406.  
Summary: In a blinded study, Infasurf was given to 569 infants with RDS versus 557 given Exosurf. Infasurf had fewer air-leaks than Exosurf, 11% to 21% (P≤0.0001) and a greater reduction in severity of RDS.
1997 Hudak, ML et al
A multicenter randomized masked comparison trial of synthetic surfactant versus calf lung surfactant extract in the prevention of neonatal respiratory distress syndrome. Peds. 1997;100:39-50.  
Summary: Infasurf was given to 433 infants and Exosurf to 438 infants<29 weeks gestation at birth. Infants treated with Infasurf had lower incidence of RDS (16% to 42%) and less severe RDS.
1997 Bloom, BT et al
Comparison of Infasurf (calf lung surfactant extract) to Survanta (Beractant) in the treatment and prevention of RDS. Peds. 1997;100:30-38.  
Summary: Infasurf and Survanta were given in two arms: prophylaxis and treatment for RDS. There were no significant differences seen in the prophylaxis-treated patients. The Infasurf group in the treatment arm had less severe RDS.
1999 Willson, DF et al
Instillation of calf lung surfactant extract (calfactant) is beneficial in pediatric acute hypoxemic respiratory failure. Crit Care Med. 1999;27:188-195.  
Summary: Infasurf resulted in rapid improvement in oxygenation, earlier extubation and reduction in intensive care duration in 21 children 1 month to 18 years old with acute hypoxemic respiratory failure compared to 21 placebo controls.
2000 Kattwinkel, J et al
High versus low threshold surfactant re-treatment for neonatal respiratory distress syndrome. Peds. 2000;106:282-288.  
Summary: Equal efficacy observed using 40% FiO2 threshold for re-treatment in uncomplicated RDS patients, but not RDS complicated by asphyxia or possible perinatal infection.
 
Web References Bibliography

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Pumactant and poractant alfa for treatment of respiratory distress syndrome in neonates born at 25-29 weeks’ gestation: a randomized trial.  Lancet. 2000;355:1387-1392.

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Comparison of Infasurf (calf lung surfactant extract) to Survanta (Beractant) in the treatment and prevention of RDS. Pediatrics. 1997;100:31-38.

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Improved outcome at 28 days of age for very low birth-weight infants treated with a single dose of a synthetic surfactant. J Pediatr. 1990;117:947-953.

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Decreased mortality rate among small premature infants treated at birth with a single dose of synthetic surfactant: A multicenter controlled trial. J Pediatr. 1991;118:595-605.

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Tracheal deposition of surfactant before the first breath. Am Rev Respir Dis. 1973;22:126-132.

Enhorning G et al

Prevention of neonatal respiratory distress syndrome by tracheal instillation of surfactant: A randomized clinical trial. Pediatrics. 1985;76:145-153.

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Artificial surfactant therapy in hyaline membrane disease. Lancet. 1980;1:55-59.

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Hudak ML et al

A multicenter randomized masked comparison of natural vs synthetic surfactant for the treatment of respiratory distress syndrome. J Pediatr. 1996;128:396-406.

Hudak ML et al

A multicenter randomized masked comparison trial of synthetic surfactant versus calf lung surfactant extract in the prevention of neonatal respiratory distress syndrome. Pediatrics. 1997;100:39-50.

King DM et al

Bulk shear viscosities of endogenous and exogenous lung surfactants. Am J Physiol Lung Cell Mol Physiol. 2002;282:L277-84.

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A case of isiopathic respiratory distress syndrome treated by newly developed surfactant (Surfactant CK). J Jpn Med Soc Biol Interface. 1981;12:1-6.

Kwong MS et al

A double blind clinical trial of calf lung surfactant extract for the prevention of hyaline membrane disease in extremely premature infants. Pediatrics. 1985;76:585-592.

Liechty EA et al

Reduction of neonatal mortality after multiple doses of bovine surfactant in low birth weight neonates with respiratory distress syndrome. Pediatrics. 1991;88:19-28.

Long W et al

A controlled trial of synthetic surfactant in infants weighing 1,250g or more with respiratory distress syndrome. N Engl J Med. 1991;325:1696-1703.

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Prophylactic treatment of very premature infants with human surfactant. N Engl J Med. 1986;315:785-790.

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Component-specific surface and physiological activity in bovine-derived lung surfactants. Chem Phys Lipids. 2002;114:21-34.

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Comparison of clinical responses to natural and synthetic surfactants. J Perinat Med. 1993;21:341-347.

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Modified bovine surfactant (Survanta) vs a protein-free surfactant (Exosurf) in the treatment of respiratory distress syndrome in preterm infants: A pilot study. J Natl Med Assoc. 1994;86:46-52.

Smyth J et al

Hyaline membrane disease treated with bovine surfactant. Pediatrics. 1983;71:913-917.

Speer CP et al

Randomised clinical trial of two treatment regimens of natural surfactant preparations in neonatal respiratory distress syndrome. Arch Dis Child. 1995;72:F8-F13.

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Ten center trial of artificial surfactant (artificial lung expanding compound ALEC) in very premature babies. Br Med J. 1987;294:991-996.

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Instillation of calf lung surfactant extract (calfactant) is beneficial in pediatric acute hypoxemic respiratory failure. Crit Care Med. 1999;27:188-195.