A 32-week preterm infant develops respiratory distress within 2 hours of birth. CXR shows bilateral ground-glass opacities with air bronchograms and reduced lung volumes. Surfactant therapy is given. The surfactant preparation currently preferred due to clinical superiority in clinical trials is:

• A Natural (animal-derived) surfactant — beractant or poractant alfa — superior to synthetic preparations ✓
• B Synthetic surfactant (colfosceril palmitate — Exosurf)
• C Synthetic recombinant surfactant — lucinactant — first-line for all preterm infants
• D Air insufflation therapy — avoids surfactant side effects

Explanation

Natural (animal-derived) surfactants — beractant (bovine; Survanta) and poractant alfa (porcine; Curosurf) — contain surfactant-associated proteins (SP-B and SP-C analogs) and have superior clinical outcomes compared to older synthetic preparations (colfosceril). Poractant alfa at 200 mg/kg may have marginally faster improvement than beractant. Lucinactant is a synthetic peptide-containing surfactant and is not universally first-line. INSURE (Intubation, Surfactant, Extubation) and LISA/MIST techniques are currently preferred delivery methods.

Reference: Ghai Essential Pediatrics, 10th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.