Comparison of Clinical Outcomes Between Calfactant and Poractant-Alfa in Preterm Infants with Respiratory Distress Syndrome

Background: This study compares short- and mid-term morbidity and mortality outcomes in preterm infants treated with the natural surfactants poractant alfa and calfactant, to assess differences in their clinical efficacy and safety profiles. Methods: In this prospective cohort study, preterm infants (25 0⁄7–32 6⁄7 weeks gestation) admitted to a Level III NICU between January 2023 and March 2024 received either poractant alfa or calfactant according to hospital supply. The primary outcome was moderate-to-severe bronchopulmonary dysplasia (BPD) and/or mortality. Secondary outcomes included extubation success, need for repeat surfactant dosing, and treatment cost per patient. Short- and mid-term morbidity and mortality outcomes were compared between groups. Results: The study included 215 preterm infants (137 in the poractant alfa group; 78 in the calfactant group). Use of less invasive surfactant administration (LISA) and INSURE techniques was significantly higher in the poractant alfa group (32.8% vs. 10.3%; p < 0.01). Poractant alfa was administered earlier, at higher per-kg doses, and at lower median treatment cost. Rates of moderate-to-severe BPD, the composite outcome BPD or mortality, reintubation, duration of respiratory support, and length of hospitalization did not differ significantly between groups. In the poractant alfa group, the need for a second surfactant dose was lower (p = 0.027). Overall mortality was similar (21.2% vs. 24.4%; p = 0.13), with no significant difference in timing of death. Conclusions: Compared with calfactant, poractant alfa offers practical advantages—such as a higher initial dose, lower cost, and reduced need for a second repeat dose—while yielding comparable short- and mid-term morbidity and mortality outcomes.