***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Objective : Natural surfactant preparations have been shown to reduce the severity and mortality of  respiratory distress syndrome ( RDS ) in preterm infants . The objective of this study was to compare the efficacy of two natural surfactants , namely SF-RI 1 ( Alveofact ® ) and barectant ( Survanta ® ) , on the incidence of chronic lung disease ( CLD ) and other associated complications of RDS in preterm infants . Methods : Preterm infants with RDS requiring artificial ventilation were r and omly selected to receive an initial dose of either Alveofact or Survanta . The two treatment groups were tested for variation in gas exchange , ventilatory setting s and neonatal complications such as CLD and mortality . Results : After 5 days the Survanta-treated infants had a lower fraction of inspired oxygen ( FiO2 ) compared with the Alveofact-treated infants . There were no differences in the ventilatory setting s. More infants in the Survanta group were extubated at 3 days and fewer required the use of postnatal steroids . Less CLD and duration of oxygenation were experienced by the Survanta-treated group . Conclusions : Improved oxygenation and reduced ventilatory requirements were greater with Survanta compared to Alveofact , which in turn was associated with a trend towards a lower incidence of serious pulmonary complications Objective To compare the complications among preterm infants treated with two different natural surfactants .  Methods In a r and omized clinical trial , 150 preterm infants with Respiratory distress syndrome ( RDS ) treated with exogenous surfactant , were enrolled in the study . Group A consisted of 79 neonates that received poractant ( curosurf ) . Seventy one newborn infants in group B were treated with beractant ( Survanta ) . Results The mean gestational age for group A and B were 29.40±2.90 wk and 29.50±2.73 wk ( P=0.82 ) , respectively . The demographic and clinical variables were similar in both groups . The mean duration of intubation ( as a primary outcome ) was significantly shorter in infants treated with poractant ( 3.13±1.80 vs 4.06±2.7 days p=0.05 ) . The mean duration of need for oxygen and hospitalization of patients in group A and B were 17.73±22.25 vs 19.14±17.85 days ( p=0.67 ) and 24.89±26.41 vs 29.14±23.54 days ( p= 0.32 ) , respectively . There was no significant difference between groups with respect to mortality and morbidity , including pulmonary hemorrhage , intraventricular hemorrhage ( IVH ) , patent ductus arteriosus , sepsis , and bronchopulmonary dysplasia ( secondary outcome ) . Conclusions In this study , infants who  received poractant had shorter duration of intubation than infants treated with beractant , without any difference in the duration of oxygen therapy or hospitalization . There was no significant superiority of poractant over beractant BACKGROUND Some controlled trials have shown significant differences in short-term clinical outcomes between poractant alfa and beractant in infants with respiratory distress syndrome ( RDS ) . There is , however , no study showing the differences in long-term outcomes with these treatments . AIM To determine and compare the neurodevelopmental outcomes of preterm infants with RDS treated with poractant alfa or beractant at 2 years of age . METHODS This was a prospect i ve , longitudinal , single-center cohort study of infants born at ≤ 1,500 g and /or ≤ 32 weeks between 2008 and 2009 who received either poractant alfa ( n = 113 ) or beractant ( n = 102 ) for RDS . Neurological and developmental assessment s were performed at a corrected age of 18 to 24 months . RESULTS About 33 of 113 infants ( 29.2 % ) in the poractant alfa group had neurodevelopmental impairment compared with 36 of 102 ( 35.2 % ) in the beractant group , and the results did not differ between the groups ( p = 0.339 ) . Similarly , no significant difference was found in the percentage of infants with cerebral palsy ( 11.5 vs. 16.7 % , respectively ; p = 0.275 ) . CONCLUSION Our findings suggest that poractant alfa and beractant are similar in terms of neurodevelopmental outcomes when used for the treatment of RDS in preterm infants In the GRADE approach , r and omized trials start as high- quality evidence and observational studies as low- quality evidence , but both can be rated down if most of the relevant evidence comes from studies that suffer from a high risk of bias . Well-established limitations of r and omized trials include failure to conceal allocation , failure to blind , loss to follow-up , and failure to appropriately consider the intention-to-treat principle . More recently recognized limitations include stopping early for apparent benefit and selective reporting of outcomes according to the results . Key limitations of observational studies include use of inappropriate controls and failure to adequately adjust for prognostic imbalance . Risk of bias may vary across outcomes ( e.g. , loss to follow-up may be far less for all-cause mortality than for quality of life ) , a consideration that many systematic review s ignore . In deciding whether to rate down for risk of bias -- whether for r and omized trials or observational studies -- authors should not take an approach that averages across studies . Rather , for any individual outcome , when there are some studies with a high risk , and some with a low risk of bias , they should consider including only the studies with a lower risk of bias Objective : Comparison of the differences between availability of animal-derived surfactant preparations used to treat premature infants is incomplete . The objective of this study was to assess the short-term treatment efficacy of the two most commonly used surfactant preparations in the United States , beractant ( 100 mg kg–1 initial and subsequent doses ) and poractant alfa ( 200 mg kg–1 initial and 100 mg kg–1 subsequent doses ) , in very premature , mechanically ventilated infants < 30 weeks gestation with respiratory distress syndrome ( RDS ) . Study Design : Inborn infants at two institutions , open label , 1:1 , r and omized controlled trial . Level of respiratory support for first 72 h of life . Morbidities of prematurity observed during the neonatal intensive care unit hospitalization . Result : We studied 52 infants 24 0/7 to 29 6/7 weeks gestation ; 25 received poractant alfa ( 27.1±1.6 weeks , birth weight of 930±231 g ) and 27 received beractant  ( 26.7±1.7 weeks , P=0.343 and birth weight 900±271 g , P=0.668 ) . Respiratory support for the first 72 h of life was lower in the poractant alfa than beractant group for mean airway pressure ( MAP , P=0.003 ) and respiratory index ( MAP × FiO2 , P=0.032 ) . Infants in the poractant alfa group had a greater number of infants extubated at 48 ( 13/25 vs 6/27 , P=0.027 ) and 72 h ( 15/25 vs 8/27 , P=0.029 ) than the beractant group . Although the study was not powered to detect morbidities of prematurity , the prevalence of PDA and air leaks was less in the infants treated with poractant alfa than in those treated with beractant  . Rates of bronchopulmonary dysplasia ( 8/23 vs 11/22 , P=0.303 ) or death ( 2/15 vs 5/27 , P=0.272 ) were similar in the infants treated with poractant alfa and beractant , respectively . Conclusion : This study suggests significant short-term benefits to the use of the larger initial dose of poractant alfa than beractant in very premature infants with RDS . Further studies involving a larger number of preterm infants are needed to assess long-term effects AIMS --To compare treatment regimens of two widely used natural surfactant preparations Curosurf and Survanta in respiratory distress syndrome ( RDS ) . METHODS --The effects of the two treatment regimens on gas exchange , ventilatory requirements , and 28 day outcome in infants with RDS were compared . Seventy five preterm infants ( birth weight 700 - 1500 g ) with RDS requiring artificial ventilation with an FIO2 of > or = 0.4 , were r and omly selected at 1 - 24 hours of age . One group received an initial dose of Curosurf ( 200 mg/kg ) ; the other group Survanta ( 100 mg/kg ) . Patients who remained dependent on artificial ventilation with an FIO2 of > or = 0.3 received up to two additional doses of Curosurf ( each of 100 mg/kg ) after 12 and 24 hours or up to three additional doses of Survanta ( each of 100 mg/kg ) between six and 48 hours after the initial dose . RESULTS --There was a rapid improvement in oxygenation and ventilatory requirements were reduced in both groups . However , infants treated with Curosurf had a higher arterial : alveolar oxygen tension ratio and required a lower peak inspiratory pressure and mean airway pressure at several time points within 24 hours of r and omisation ( p < 0.05 - 0.001 ) . The incidences of pneumothorax in the Curosurf and Survanta groups were 6 % and 12.5 % , respectively ; the corresponding figures for grade s 3 - 4 intracerebral haemorrhage were 3 % and 12.5 % , respectively . Mortality was 3 % in the Curosurf group and 12.5 % in the Survanta group . However , these differences did not reach significance . CONCLUSION --The Curosurf treatment regimen result ed in a more rapid improvement in oxygenation than Survanta and reduced ventilatory requirements up to 24 hours after start of treatment . This was associated with a trend towards reduced incidence of serious pulmonary and non-pulmonary complications Newfactan ® is a domestically developed , bovine lung-derived , semi-synthetic surfactant . The aim of this study was to compare the clinical efficacy of Newfactan ® with that of Surfacten ® in the treatment of respiratory distress syndrome ( RDS ) .  Newfactan ® or Surfacten ® was r and omly allocated to 492 newborn infants who were diagnosed as RDS and required surfactant instillation in four participating hospitals . The comparisons were made individually in two subsets of infants by birth weight ( < 1,500 g group [ n=253 ] and ≥1,500 g group [ n=239 ] ) . Short-term responses to surfactant and acute complications , such as the total doses of surfactant instilled , response type , extubation rate , ventilator setting s , changes in respiratory parameters , air leak , patent ductus arteriosus , pulmonary hemorrhage , and intraventricular hemorrhage , and mortality during the 96 hr after surfactant instillation were measured . Long-term outcome and complications , such as total duration of intubation , bronchopulmonary dysplasia and periventricular leukomalacia , and ultimate mortality were measured . There were no significant differences in demographic and perinatal variables , short-term responses to surfactant and acute complications , and long-term outcome and complications between Newfactan ® and Surfacten ® in both birth weight groups . We concluded that Newfactan ® was comparable to Surfacten ® in the clinical efficacy in the treatment of RDS in both birth weight groups Objective To compare the efficacy and safety of a new porcine-derived pulmonary surfactant developed by Instituto Butantan with those of animal-derived surfactants commercially available in Brazil , regarding neonatal mortality and the major complications of prematurity in preterm newborns with birth weight up to 1500 g and diagnosed with respiratory distress syndrome . Methods Neonates diagnosed with respiratory distress syndrome were r and omized to receive either Butantan surfactant ( Butantan group ) or one of the following surfactants : Survanta ® or Curosurf ® . Newborns receiving Survanta ® or Curosurf ® comprised the control group . The main outcome measures were mortality rates at 72 hours and at 28 days of life ; the typical complications of prematurity as evaluated on the 28th day of life were defined as secundary outcomes . Results No differences were observed between the  Butantan ( n=154 ) and control ( n=173 ) groups in relation to birth weight , gestational age , sex , and prenatal use of corticosteroids , or in mortality rates both at 72 hours ( 14.19 % versus 14.12 % ; p=0.98 ) and at 28 days ( 39.86 % versus 33.33 % ; p=0.24 ) of life . Higher 1- and 5-minute Apgar scores were observed among control group newborns . No differences were observed as regards the secondary outcomes , except for greater need for supplemental oxygen and a higher incidence of interstitial pulmonary emphysema in the Butantan group . Conclusion The mortality rates at 72 hours and 28 days of life and the incidence of major complications of prematurity were comparable to 
    Output:
    
AUTHORS ' CONCLUSIONS Significant differences in clinical outcome were noted in the comparison trials of modified minced lung surfactant extract ( beractant ) compared with porcine minced lung surfactant extract ( poractant alfa ) including a significant increase in the risk of mortality prior to discharge , death or oxygen requirement at 36 weeks ' postmenstrual age , PDA requiring treatment and " receiving > 1 dose of surfactant " in infants treated with modified bovine minced lung surfactant extract compared with porcine minced lung surfactant extract .
The difference in these outcomes was limited to studies using a higher initial dose of porcine minced lung surfactant extract .
No differences in clinical outcomes were observed in comparative trials between bovine lung lavage surfactant and modified bovine minced lung surfactants