Limitations
As far as limitations of our study, apart from being a retrospective study from across 6 centres, an important limitation of our study is that we have not collected the data on pulmonary haemorrhage and its association with the type of surfactant used. Study by Tridente et.al. favours use of porcine surfactant which had noted lesser lung haemorrhage whereas the cochrane review showed no difference.4,7 We felt lung haemorrhage having multiple etiologies in very small newborns including hemodynamically significant PDA, sepsis, DIC has more confounding factors and attributing it to type of surfactant type may not be easy in a retrospective design. Possibility of approximation of dose of surfactant due to more common whole-vial based dosing in place of exact weight-based dosing remains inherent limitation of retrospective study.13
Cost benefit analysis comparing the surfactant preparations has not been attempted owing to the varied hospital policies of billing. This precludes our assumption that bovine surfactant use may reduce the cost compared to porcine surfactants. Magni et.al. have noted that here were no significant differences in neonatal intensive care unit (NICU) length of stay or NICU total costs between infants treated with beractant (Survanta®), calfactant (Infasurf®) or poractant alfa (Curosurf®) in a study data from developed countries and funded by Chiesi Farmaceutici S.p.A.14
More data from a larger sample size, randomised controlled studies, from India may be needed to address the issues of type of surfactant usage in RDS with different morbidities and mortality.