Poractant Alfa

Pronunciation: pore-ACK-tant AL-fuh
Class: Lung surfactant

Trade Names

Curosurf
- Suspension, intratracheal 80 mg phospholipids/mL

Pharmacology

Extract of natural porcine lung surfactant that restores lung surfactant in premature infants with lung surfactant deficiency causing respiratory distress syndrome (RDS).

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Indications and Usage

Treatment of RDS in premature infants.

Unlabeled Uses

Severe meconium aspiration syndrome in term infants; respiratory failure caused by group B streptococcal infection in neonates.

Contraindications

Standard considerations.

Dosage and Administration

Newborn infants

Intratracheal Initial dose: 2.5 mL/kg birth weight. Repeat doses: Up to 2 repeat doses of 1.25 mL/kg birth weight may be administered every 12 h for total of 3 doses. Max dose (initial and up to 2 repeat doses): 5 mL/kg.

General Advice

  • Visually inspect poractant alfa for discoloration prior to administration. The color of poractant alfa is white to creamy white. Before use, warm vial to room temperature and gently turn upside down to obtain a uniform suspension. Do not shake.
  • Before administering poractant alfa, assure proper placement and patency of the endotracheal tube. The endotracheal tube may be suctioned before administering poractant alfa, but allow the infant to stabilize after suctioning before proceeding with dosing.
  • For endotracheal tube instillation using 5-French end-hole catheter: Slowly withdraw entire contents of vial of poractant alfa into a 3 or 5 mL plastic syringe through a large-gauge needle (eg, at least 20-gauge). Attach precut 8-cm 5-French end-hole catheter to syringe and fill the catheter with poractant alfa. Discard excess poractant alfa through catheter so that only the total dose to be given remains in the syringe. Immediately before administration, the ventricular setting should be changed to a rate of 40 to 60 breaths/min, inspiratory time 0.5 sec, and supplemental oxygen sufficient to maintain SaO 2 higher than 92%. Keeping the infant in a neutral position (head and body in alignment without inclination) briefly disconnect the ventilator from the endotracheal tube, insert the 5-French catheter into the endotracheal tube and instill the first aliquot (1.25 mL/kg birth weight) of poractant alfa. Position the infant so that either the right or left side is dependent for this aliquot. Remove the catheter from the endotracheal tube and manually ventilate the infant with 100% oxygen at a rate of 40 to 60 breaths/min for 1 min. When the infant is stable, reposition the infant so that other side is dependent, and administer the remaining aliquot of poractant alfa using the same technique.
  • For endotracheal tube instillation using the secondary lumen of a dual lumen endotracheal tube: Slowly withdraw entire contents of vial of poractant alfa into a 3 or 5 mL plastic syringe through a large-gauge needle (eg, at least 20-gauge). Do not attach 5-French end-hole catheter. Keeping infant in a neutral position (head and body in alignment without inclination), administer dose of poractant alfa through proximal end of the secondary lumen of endotracheal tube as a single dose over 1 min, without interrupting mechanical ventilation.
  • Do not suction airways for 1 h after surfactant instillation unless signs of significant airway obstruction occur.

Storage/Stability

Store vials in refrigerator (36° to 46°F). Unopened vials may be warmed to room temperature for up to 24 h prior to use. Unopened vials that have been warmed to room temperature may be returned to refrigerated storage within 24 h for future use. Do not warm and return to refrigerator more than once. Protect from light. Vials are for single use only. Discard any unused portion of poractant alfa. Do not save unused portions for future use.

Drug Interactions

None well documented.

Laboratory Test Interactions

None well documented.

Adverse Reactions

Cardiovascular

Transient bradycardia; hypotension.

Miscellaneous

Transient endotracheal tube blockage; oxygen desaturation.

Precautions

Monitor

Poractant alfa can rapidly affect oxygen and lung compliance; monitor patient frequently so that oxygen and ventilatory support can be modified to respond to changes in respiratory status.


Dosing

During administration of poractant alfa, monitor the infant for bradycardia, hypotension, endotracheal tube blockage (reflux of poractant alfa into endotracheal tube), or oxygen desaturation. If any of these events occur, interrupt administration and take appropriate measures to alleviate the condition. After the patient is stable, dosing may proceed with appropriate monitoring.

Preadministration

Ensure that efforts are made to correct acidosis, hypotension, anemia, hypoglycemia, and hypothermia before administering poractant alfa.

Patient Information

  • Advise family or caregiver that medication will be prepared and administered by health care professionals while the patient is in the intensive care unit.
  • Advise family or caregiver that poractant alfa can be expected to reduce the severity of RDS but will not affect other complications of prematurity.

Copyright © 2009 Wolters Kluwer Health.

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