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Table 1 Mechanisms linking surfactant replacement to non-respiratory neonatal outcomes, as per animal or human translational investigations

From: Porcine versus bovine surfactant therapy for RDS in preterm neonates: pragmatic meta-analysis and review of physiopathological plausibility of the effects on extra-pulmonary outcomes

 Physiopathological mechanismsHypothesizedConfirmed
PDA↓ oxygen and ROS exposure [46,47,48,49]
↓ Prostaglandins synthesis [50, 51]
↓ PVR [46, 47, 52,53,54]
IVH↓ PaCO2 and CBF[55,56,57] 
↓ PDA[53, 54] 
Better peripheral perfusion[34, 42] 
Improved cerebral oxygenation[58] 
ROP↓ oxygen and ROS exposure[49, 59,60,61,62,63] 
NEC↓ oxygen and ROS exposure[49, 64] 
Better peripheral perfusion[34, 42] 
Earlier progression to full enteral feeding[65,66,67,68] 
  1. More details in the text. Abbreviations: ROS Reactive oxygen species, PVR Pulmonary vascular resistances, CBF Cerebral blood flow, PaCO2 Arterial partial pressure of CO2, PDA Patent ductus arteriosus, IVH Intraventricular hemorrhage, ROP Retinopathy of prematurity, NEC Necrotizing enterocolitis