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PIPER - Paediatric Infant Perinatal Emergency Retrieval

Poractant Alfa (Curosurf)

  • Description and indication for use

    Poractant Alfa is an exogenous pulmonary Surfactant extracted from porcine lungs. It decreases surface tension of the lungs, thereby improving lung expansion and gaseous exchange. Poractant Alfa helps reduce lung tissue damage. It is used for ventilated infants who are either at high risk of Respiratory Distress Syndrome (prophylaxis) or are suffering from Respiratory Distress Syndrome (rescue).

    Criteria for Use

    Prophylactic: intubated and ventilated babies 30 weeks gestation or less, as soon as possible after intubation (preferably within 15 minutes).

    Babies should not be intubated solely to administer surfactant.

    Rescue: ventilated infants with RDS, who require more than 40% oxygen to maintain their oxygen saturation between 91% and 95%.

    Surfactant use in circumstances other than the above should be discussed with the consultant.

    Dose

    ETT:  200 mg/kg (2.5 mL/kg) bolus4, 11  

    A number of studies support higher dosing regimens with an initial dose of 200 mg/kg, followed by 100 mg/kg as determined by clinical parameters.

    Poractant Alfa is packaged in 1.5 mL vials (120 mg). Whilst we are keen to minimise the opening of additional vials, a large number of babies could receive a higher dose of Surfactant by administering the Surfactant that would usually be discarded. The following regimen is recommended.

    Weight range       Surfactant dose range Initial Curosurf® volume
    <600g 200 mg/kg 2.5 mL/kg
    600g to 1.2kg 200 mg/kg to 100 mg/kg 1.5 mL
    1.2kg to 2.4kg 200 mg/kg to 100 mg/kg 3 mL
    2.4kg to 3.6kg 150 mg/kg to 100 mg/kg 4.5 mL
    >3.6kg Consider carefully the indications for Surfactant in this population.

    Preparation

    Poractant Alfa is available in vial sizes 120 mg in 1.5 mL and 240 mg in 3 mL.

    Allow Poractant Alfa to reach room temperature. Artificial warming methods should not be used.

    Give undiluted.

    DO NOT SHAKE.

    Do not access or re-warm vial more than twice.

    Route and method of administration

    To be administered via endotracheal tube only

    Poractant Alfa is administered as a bolus, via the endotracheal tube, using a syringe containing the appropriate dose of Poractant Alfa, attached to a shortened, 5 French end-hole catheter.6

    Side effects

    The administration of Poractant Alfa can rapidly affect oxygenation and lung compliance.

    Transient effects:

    Bradycardia.

    Hypotension.

    Endotracheal tube blockage.

    Oxygen desaturation and bradycardia.

    Severe effects:

    Pneumothorax.

    Special considerations

    Before administering Poractant Alfa:

    Ensure proper placement and patency of the endotracheal tube.

    Suction ETT as necessary.

    Cardio-respiratory monitoring and pulse oximeter must be in-situ (minimum requirement)

    After administration of Poractant Alfa:

    Observe for chest movement to ensure that Surfactant has reached the lungs.

    Adjust oxygen requirements as needed and ventilation requirements according to oximetry, tidal volumes and blood gases.

    Do not suction ETT for at least 1 hour after administration unless clinically unavoidable.

    Religious Considerations

    Jewish Infants

    Poractant Alfa can be administered to Jewish infants for the following reasons:

    1) it is life saving.

    2) it is inhaled and not ingested.

    Muslim Infants

    Muslims are allowed to consume medications which contain pig by-products if they are life saving. Pork derivatives are prohibited when taken by mouth or in diet but not if they are used for indications other than food or diet e.g. intratracheal instillation.2,3

    Compatibility Information

    Poractant Alfa is not to be diluted or mixed with any other products.

    References:

    1.    The Position of Jewish Halacha towards Curosurf (a porcine derived surfactant). A summary document, Rabbi Mordechai Halperin M.D. 19th Dec., 2004.
    2.    Use of Animal Surfactant: should we seek consent? R.Adappa, R.Benson, S.Oddie, J.Wylie, ADC 2003; 88(4):351.
    3.    Use of Animal Surfactant: a religious perspective, Murat Yurdakok. Electronic letters to the editor..ADC 2003; 88(4): 351.
    4.    4.Multicentre randomised trial comparing high and low dose Surfactant regimens for the treatment of RDS (the Curosurf trial) Halliday et al. ADC 1993;69: 276-280.
    5.    Guidelines for use of multi-access vials, RWH pharmacy, K.McMillan, C.Morley, 2003.
    6.    Surfactant Administration.  RWH Policy and Procedure Manual 9W-04-2-121.
    7.    MIMS online (www.mimsonline.com.au – accessed 03/10/2013).
    8.    Northern Network Neonatal Formulary, 11th ed. 2011.

Disclaimer:  This Drug information was designed for use by PIPER Neonatal. Whilst great care has been taken to check the information is accurate, it is possible that errors may have been missed. Furthermore, dosage schedules are continually being revised and new side effects recognised. For these reasons, the reader is strongly advised to consult the drug companies' printed information before administering any of the drugs recommended in this book.
Most drugs in this document are appropriate only for specialist use in hospitals.  A number of drugs should only be used in consultation with the appropriate Paediatric subspecialist. 

Note: The electronic version of this guideline is the version currently in use.  Any printed version cannot be assumed to be current. Printed copies of this document are valid for