Surfactants
Synonyms :
Beractant, Calfactant, Lucinactant, Poractant Alfa
Mechanism :
Endogenous pulmonary surfactant lowers surface tension on alveolar surfaces during respiration and stabilizes the alveoli against collapse at resting transpulmonary pressures. Deficiency of pulmonary surfactant causes Respiratory Distress Syndrome (RDS) in premature infants. Natural surfactant, a combination of lipids and apoproteins, exhibits not only surface tension-reducing properties (conferred by the lipids), but also rapid spreading and adsorption (conferred by the apoproteins.
Indication :
- Prevention and treatment of respiratory distress syndrome in newborns
Contraindications :
Stabilise the baby before administration. Be prepared to make early adjustments to ventilation to take account of possible rapid improvement in lung compliance following surfactant administration.
Dosing :
Poractant alfa:
1.25-2.5 ml/kg within 15 mins of birth, for prevention.
Treatment: 2.5 ml/kg birth weight intratracheal, then, 1.25 ml/kg every 12 hours, two times as needed. Max: 5 ml/kg total.
Beractant:
4 ml/kg (1 ml = 100 mg) within 15 mins of birth, intratracheal for prevention.
Treatment: 4 ml/kg within 8 hours of birth intratracheal. May administer 4 doses during 48 hours.
Calfactant:
3 ml/kg intratracheal every 12 hours for upto 3 doses.
Lucinactant:
5.8 ml/kg intratracheal. Divide dose into 4 aliquots to administer. May administer 4 doses during 48 hours.
Adverse Effect :
Transient bradycardia is most frequently seen, also endotracheal tube reflux, pallor, vasoconstriction, hypotension, endotracheal tube blockage, hypertension, hypocarbia, hypercarbia, and apnea have been reported.
Interaction :
No known interactions found.
Hepatic Dose :
No dosage adjustments are recommended.