surfactant

Beractant

Survanta

Route: intratracheal
Onset: Minutes (immediate reduction in oxygen requirements)
Duration: Variable — may require repeat dosing

Mechanism of action

Natural bovine lung surfactant extract. Contains phospholipids (primarily DPPC), neutral lipids, fatty acids, and surfactant proteins SP-B and SP-C. Reduces alveolar surface tension → prevents alveolar collapse at end-expiration.

Dosing

Neonatal: 4 mL/kg (100 mg/kg) intratracheally. May give up to 4 doses in first 48 hr, minimum 6 hr between doses

Indications

Respiratory Distress Syndrome (RDS) in premature neonates
Prevention of RDS (prophylactic) in high-risk preterm infants (<1250 g or <32 weeks)
Rescue treatment of established RDS

Contraindications

No absolute contraindications in RDS
Congenital anomalies incompatible with life

Side effects

Transient bradycardia during instillation
Oxygen desaturation during instillation
Reflux into ETT
Pulmonary hemorrhage (rare)
Pneumothorax (can occur secondary to improved compliance)

Monitoring parameters

SpO2 continuously during instillation
Heart rate
Chest rise and bilateral breath sounds
Ventilator pressures (rapid improvement may require immediate reduction)
Blood gas after administration

Drug interactions

None significant

NBRC high-yield

Bovine natural surfactant — 4 mL/kg (100 mg/kg) intratracheal
For RDS in premature neonates
Warm to room temperature; do NOT shake; give in quarter-doses
Monitor for rapid compliance improvement → wean vent immediately
Bradycardia and desaturation during instillation are common
Up to 4 doses in 48 hours; ≥6 hours between doses

Clinical pearls

Warm to room temperature before administration — do NOT shake
Administer in multiple aliquots (usually 4 quarter-doses) with repositioning between each
Rapid improvement in compliance — immediately wean FiO2 and PIP to prevent barotrauma
Prophylactic use (within 15 min of birth) vs. early rescue (within 2 hr) are preferred strategies
Bovine-derived — theoretical BSE concern, but no cases reported
Refrigerate; expires 12 hours after warming

Mnemonic

Survanta = SURface tension VANquisher — Tame the Alveoli

All Drugs

NBRC high-yield

Bovine natural surfactant — 4 mL/kg (100 mg/kg) intratracheal

For RDS in premature neonates

Warm to room temperature; do NOT shake; give in quarter-doses

Monitor for rapid compliance improvement → wean vent immediately

Bradycardia and desaturation during instillation are common

Up to 4 doses in 48 hours; ≥6 hours between doses

Clinical pearls

Warm to room temperature before administration — do NOT shake

Administer in multiple aliquots (usually 4 quarter-doses) with repositioning between each

Rapid improvement in compliance — immediately wean FiO2 and PIP to prevent barotrauma

Prophylactic use (within 15 min of birth) vs. early rescue (within 2 hr) are preferred strategies

Bovine-derived — theoretical BSE concern, but no cases reported

Refrigerate; expires 12 hours after warming