Comparison of Bovine Lipid Extract Surfactant and Poractant Alfa Administered via LISA in Preterm Infants(28

Summary

In a single-center RCT in India (n=282), BLES delivered via LISA was clinically equivalent to poractant alfa for preterm RDS, with similar intubation rates and morbidities. Drug cost per infant was substantially lower with BLES, supporting a cost-effective alternative in resource-limited settings.

Key Findings

• No difference in 72-hour intubation (13.5% BLES vs 11.3% poractant alfa; p=0.710).
• Physiologic parameters (FiO2, SpO2, HR, MAP) and major morbidities/mortality were similar across groups.
• Drug cost per infant was significantly lower with BLES (INR 20,539 vs 29,677; p<0.001).

Clinical Implications

BLES can be adopted as a lower-cost surfactant option without compromising outcomes when using LISA in preterm RDS, aiding scale-up of non-invasive respiratory care in LMIC NICUs.

Limitations

• Single-center, open-label design may limit generalizability and introduce performance bias.
• Eligibility details (e.g., gestational age completion criteria) and blinding not fully described in abstract.

Future Directions

Multicenter, blinded, non-inferiority trials powered for clinically important outcomes (BPD, mortality) and full cost-utility analyses across diverse LMICs.