Respiratory Distress Syndrome Medication

Updated: Jan 16, 2015
  • Author: Arun K Pramanik, MD, MBBS; Chief Editor: Ted Rosenkrantz, MD  more...
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Medication

Medication Summary

As previously mentioned, the advent of surfactant therapy has reduced the mortality rate from respiratory distress syndrome by approximately 50%. However, the ideal surfactant preparation to treat premature infants with respiratory distress syndrome and its sequelae has not been identified. [37, 38]

Because surfactant protects the immature lungs, several investigators have recommended its prophylactic use after resuscitation in extremely premature neonates (< 27 weeks' gestation).

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Lung Surfactants

Class Summary

Exogenous surfactant can be helpful in treating respiratory distress syndrome (RDS). It has also been used in treating newborn infants with meconium aspiration syndrome, pneumonia, and pulmonary hemorrhage. In RDS, after intratracheal administration of surfactant, surface tension is reduced, alveoli are stabilized, work of breathing is decreased, and lung compliance is increased.

A number of studies have demonstrated the critical function of SP-B or specific SP-B peptide sequences in pulmonary surfactant, particularly the highly conserved amino- and carboxyl-terminal sequences consisting of a repeating arginine-lysine (R-L) motif (RL4).

The evolution of surfactants from modified animal surfactant has included use of selective peptide sequences of SP-B; synthetic peptide mimics, including RL4 and KL4; modification of SP-C; and peptoids of SP-B and SP-C.

In head-to-head clinical trials to compare synthetic surfactant with animal-derived preparations, animal-derived surfactants were superior, with immediate benefits in pulmonary air leaks, intraventricular hemorrhage, bronchopulmonary dysplasia (BPD), and mortality.

Beractant (Survanta)

Beractant is a natural/modified bovine lung extract that lowers surface tension on alveolar surfaces during respiration and stabilizes alveoli against collapse at resting transpulmonary pressures. For endotracheal (ET) use only. Survanta contains 10% SP-B.

Poractant (Curosurf)

Poractant lowers surface tension on alveolar surfaces during respiration and stabilizes alveoli against collapse at resting transpulmonary pressures. It is indicated to treat respiratory distress syndrome in premature infants. Poractant is for ET use only. Curosurf has an SP-B content of 30%.

Calfactant (Infasurf)

Calfactant is a natural calf lung extract containing phospholipids, fatty acids, and surfactant-associated proteins B (260mcg/mL) and C (390mcg/mL). It is for ET use only.

Lucinactant (Surfaxin)

Synthetic KL4 protein (sinapultide) similar to SP-B. Contains DPPC and palmitoyloleoyl phosphatidylcholine (POPG) phospholipids.

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