{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,17]],"date-time":"2026-08-17T14:53:22Z","timestamp":1786978402519,"version":"build-2736575974"},"reference-count":39,"publisher":"Wiley","issue":"9","license":[{"start":{"date-parts":[[2025,9,9]],"date-time":"2025-09-09T00:00:00Z","timestamp":1757376000000},"content-version":"vor","delay-in-days":8,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Pediatric Pulmonology"],"published-print":{"date-parts":[[2025,9]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Respiratory distress syndrome (RDS) is a leading cause of neonatal morbidity and mortality in low\u2010 and middle\u2010income countries (LMICs). The feasibility and effectiveness of bovine versus porcine surfactants via less invasive surfactant administration (LISA) remain unstudied in LMICs. We compared clinical outcomes and cost\u2010effectiveness of BLES versus poractant alfa in preterm infants with RDS managed with LISA.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      This randomized controlled trial was conducted in a level 3 neonatal intensive care unit in India. Eligible preterm infants born between 28\n                      <jats:sup>+0<\/jats:sup>\n                      and 34\n                      <jats:sup>+6<\/jats:sup>\n                      weeks of gestation who developed RDS requiring Noninvasive respiratory support and supplemental oxygen (FiO\u2082 \u2265\u200930%) within 6\u2009h of birth were enrolled. Infants were randomly assigned (1:1) to receive either BLES 135\u2009mg\/kg (5\u2009mL\/kg) or poractant alfa 200\u2009mg\/kg (2.5\u2009mL\/kg) via the LISA technique. The primary outcome was need for intubation within 72\u2009h of life.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Result<\/jats:title>\n                    <jats:p>\n                      From Jan 24, 2024 to Mar 15, 2025, 282 infants were randomized to BLES or poractant alfa (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u2009141 each). Intubation within 72\u2009h occurred in 19 (13.5%) infants in the BLES group and 16 (11.3%) in the poractant alfa group (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.710). There were no statistically significant differences in FiO\u2082, SpO\u2082, heart rate, or mean airway pressure at any time point before or after surfactant administration between the two groups. No significant differences were observed in major morbidities or mortality. The average cost of surfactant per infant was significantly lower with BLES (INR 20,539 vs 29,677;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>In LMIC settings, BLES and poractant alfa showed similar effectiveness for RDS management via LISA, with no difference in clinical outcomes. BLES provides a cost\u2010effective alternative in resource\u2010constrained neonatal care.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/ppul.71281","type":"journal-article","created":{"date-parts":[[2025,9,9]],"date-time":"2025-09-09T11:54:41Z","timestamp":1757418881000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Comparison of Bovine Lipid Extract Surfactant and Poractant Alfa Administered via LISA in Preterm Infants(28\n                    <sup>+0<\/sup>\n                    to 34\n                    <sup>+6<\/sup>\n                    Week) With Respiratory Distress Syndrome: A Randomized Controlled Trial"],"prefix":"10.1002","volume":"60","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-0990-392X","authenticated-orcid":false,"given":"Ashadur","family":"Zamal","sequence":"first","affiliation":[{"name":"Department of Neonatology Institute of Post Graduate Medical Education &amp; Research and SSKM Hospital Kolkata India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8658-5713","authenticated-orcid":false,"given":"Md Habibullah","family":"Sk","sequence":"additional","affiliation":[{"name":"Department of Neonatology Institute of Post Graduate Medical Education &amp; Research and SSKM Hospital Kolkata India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8104-9225","authenticated-orcid":false,"given":"Bijan","family":"Saha","sequence":"additional","affiliation":[{"name":"Department of Neonatology Institute of Post Graduate Medical Education &amp; Research and SSKM Hospital Kolkata India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3561-1365","authenticated-orcid":false,"given":"Avijit","family":"Hazra","sequence":"additional","affiliation":[{"name":"Department of Pharmacology Institute of Post Graduate Medical Education &amp; Research and SSKM Hospital Kolkata India"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2025,9,9]]},"reference":[{"key":"e_1_2_9_2_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(23)00878-4"},{"key":"e_1_2_9_3_1","doi-asserted-by":"publisher","DOI":"10.1002\/ppul.24241"},{"key":"e_1_2_9_4_1","doi-asserted-by":"publisher","DOI":"10.1542\/neo.7-2-e95"},{"key":"e_1_2_9_5_1","doi-asserted-by":"publisher","DOI":"10.1038\/s41390-022-02265-8"},{"key":"e_1_2_9_6_1","doi-asserted-by":"publisher","DOI":"10.1159\/000326628"},{"key":"e_1_2_9_7_1","unstructured":"Neosurf[package insert]. 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