BACKGROUND & OBJECTIVES: Porcine surfactant (200 mg/kg initial dose) seems to be superior over bovine surfactants (100 mg/kg) in respiratory distress syndrome (RDS). There is limited data on choice of surfactant from the developing world. Logically using higher doses of porcine surfactant comes with additional burden of cost. We decided to evaluate the clinical effect of different types of surfactants. METHODS: A retrospective analysis was conducted from August 2019 to December 2022 in 6 tertiary centres. Neonates 24-34 weeks of gestation with RDS requiring either porcine (200 mg/kg) or bovine surfactant (100 mg/kg) were enrolled. The proportion of combined outcomes of death and or CLD, redosing and other morbidities in either group were analysed. The subgroup of preterm >28 weeks and outcomes between different surfactants were analysed. RESULTS: Out of 1149 eligible babies, 302 (26%) received surfactant after stabilisation with CPAP. 158 received porcine and 144 received bovine surfactant via INSURE technique. There was a higher combined outcome of death or CLD in porcine compared to the bovine group [48 (30%) vs 20 (13%), OR:2.7; 95% CI:1.5-4.8; p=0.001] and similar combined outcomes in >28 weeks sub-group. Redosing [27 (17%) Vs 18 (12%), OR:1.4; 95% CI:0.7-2.7; p=0.2] was similar. Other morbidities like air leak, invasive ventilation, CPAP duration were similar between both the groups and different types of surfactants. CONCLUSION: Porcine surfactant at 200mg/kg had similar combined outcomes of death/ CLD and redosing compared to bovine surfactant in preterm >28 weeks. Considering the cost burden in the developing world, the efficacy needs evaluation in randomised clinical trials.

Background and Objective: With improved survival in neonates with meconium aspiration syndrome (MAS), the focus is currently on mitigating the morbidities. The objective of this study was to predict factors determining prolonged hospital stay in neonates with MAS. Materials and methods: It was a retrospective cohort from five centres of south India between 2018 and 2020. Neonates ≥35 weeks of gestation admitted to NICU with the diagnosis of MAS and requiring oxygen beyond 24 hours of life were included in the study. The morbidities in the neonates with stay ≤7 days (short stay) were compared with >7 days (prolonged stay). Logistic regression by the backward stepwise method was used for predictive score creation. Results: Out of 347 neonates with MAS discharged home, 103 (29%) had a short stay and 244 (71%) had prolonged stay. The primary support beyond O2 (CPAP/MV) (42% vs 83%, p<0.001), FiO2 at 1hr>30% (45% vs 87%, p<0.001), HIE stage 2 or 3 (2% vs 27%, p<0.001), moderate-severe PPHN (3% vs 31%, p<0.001) were independent factors associated with prolonged stay on logistic regression. A prediction model was devised using weighted scores of these four associated morbidities. The clinical score thus developed had 83% sensitivity, 68% specificity for the prediction of prolonged stay [AUC- 82, 95% CI (78-87), p<0.001]. Conclusion: More than two-thirds of neonates with MAS had prolonged stay. The primary support beyond oxygen, Fio2 requirement >30%, Moderate to severe PPHN, HIE stage 2 or 3 were predictive of prolonged stay in neonates with MAS.