Efectividad del surfactante pulmonar bovino frente a los surfactantes artificiales en pacientes prematuros con Síndrome de Dificultad Respiratoria Neonatal. Revisión sistemática

Abstract

Objective: To determine the comparative effectiveness of bovine pulmonary surfactant versus synthetic surfactants in preterm infants with neonatal respiratory distress syndrome (NRDS). Methodology: A review of clinical trials published since 2014 was conducted, including preterm infants diagnosed with NRDS treated with surfactants. Studies that were not clinical trials or that did not fall within the established time frame were excluded. The literature search was conducted in the PubMed, Medline, Ovid, and Cochrane databases. The risk of bias and methodological quality of the articles were assessed using the Cochrane Rob 2 tool in its Excel version. Results: The analysis included 11 randomized, blinded, double-blind, and open-label clinical trials involving diverse populations of preterm infants with NRDS. The findings showed that natural bovine surfactant was associated with a lower rate of complications, shorter duration of mechanical ventilation, and reduced need for supplemental oxygen compared with synthetic surfactants. Furthermore, the therapeutic effect showed better results when combined with budesonide. Regarding administration methods, strategies such as INSURE and INRECSURE were associated with reduced neonatal morbidity and mortality. Discussion: Publication bias was identified due to inconsistencies in reports of mortality and treatment failure. Limitations: Data heterogeneity made it difficult to establish absolute superiority among surfactants. Conclusion: Pulmonary surfactants remain the best therapeutic option for the treatment of neonatal respiratory distress syndrome in preterm infants. Keywords: pulmonary surfactant, respiratory distress syndrome, artificial surfactant, pneumothorax