Medication Summary

The principal therapies for pulmonary interstitial emphysema (PIE) are lateral decubitus positioning, selective intubation, occlusion of the contralateral bronchus, and high-frequency ventilation. However, administration of surfactant to premature infants (< 30-32 weeks' gestation) judged to be at risk of developing respiratory distress syndrome may reduce the risk of PIE development.

Class Summary

These agents prevent the alveoli from collapsing during expiration that results from deficient or ineffective endogenous lung surfactant in neonates. There are two different kinds: Natural and Synthetic. It is for intratracheal administration only. Surfactant prevents alveoli from collapsing during expiration by lowering the surface tension between air and alveolar surfaces. Surfactant is used for prophylaxis and treatment of respiratory distress syndrome (RDS) in premature infants.

Beractant (Survanta®), Poractant (Curosurf®), Calfactant (Infasurf®)

It is derived from animals. It has been considered the superior subtype, due to its greater efficacy in mimicking the action of human surfactant. The value between the two subtypes has yet to be fully elucidated. Bovine samples are most commonly used followed by porcine extracts. Despite the positive findings when natural surfactant is administered, there are a number of drawbacks, including the lack of cost-effectiveness, inconsistent efficacy, possible anaphylactic shock reaction, and risk of pathogen contamination. It is important to note that the pathogenic risks have not been identified on a clinical level.

Beractant (Survanta^®) is animal surfactant derived from minced bovine lung extract, with the added products of DPPC, palmitic acid and tripalmitin.

Poractant (Curosurf®) is derived from minced porcine lungs.

Calfactant (Infasurf®) is another bovine surfactant extracted by broncho-alveolar lavage

Exosurf®, Lucinactant (Surfaxin®)

It is produced synthetically in laboratory. Previous synthetic surfactant only contained phospholipids, with colfosceril palmitate (Exosurf^®) the most commonly trialled protein-free synthetic surfactant The prime factor has been the development of protein-containing synthetic surfactant. It had been shown that its therapeutic effect was inferior to that of natural surfactant. The rise of protein-containing synthetic surfactant, such as lucinactant (Surfaxin^®), has offered scientists a new avenue to further expand upon our advancement in surfactant as its action has been hypothesised to be as effective as, or even better than, natural surfactant.

Questions

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Media Gallery

This radiograph, obtained from a 1-day-old premature infant at 24 weeks' gestation, shows bilateral pulmonary interstitial emphysema (PIE). Linear radiolucencies extending up to the lung periphery are visible.
This radiograph, obtained from a premature infant at 26 weeks' gestation, shows characteristic radiographic changes of pulmonary interstitial emphysema (PIE) of the right lung.
This radiograph shows pneumothorax and pulmonary interstitial emphysema (PIE) on the right side. Interstitial air prevents collapse of the underlying lung by a tension pneumothorax. In such cases, extreme caution is required during drainage of a pneumothorax to avoid perforation of the underlying lung.

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Author

Abhay J Bhatt, MD, MBBS Professor, Department of Pediatrics, Division of Neonatology, Clinical Science Director, Center for Developmental Disorders Research, University of Mississippi Medical Center

Abhay J Bhatt, MD, MBBS is a member of the following medical societies: Society for Pediatric Research

Disclosure: Nothing to disclose.

Coauthor(s)

Rita M Ryan, MD Chair and Professor, Department of Pediatrics, Medical University of South Carolina College of Medicine; Pediatrician-in-Chief, Division of Neonatology, MUSC Children's Hospital

Rita M Ryan, MD is a member of the following medical societies: American Academy of Pediatrics, American Pediatric Society, American Physiological Society, American Thoracic Society, Irish and American Paediatric Society, Perinatal Research Society, Society for Pediatric Research, Southern Society for Pediatric Research

Disclosure: Nothing to disclose.

Jagdish Desai, MD, MPH Assistant Professor of Pediatrics, Neonatologist, University of Mississippi Medical Center

Jagdish Desai, MD, MPH is a member of the following medical societies: American Academy of Pediatrics, American Association of Physicians of Indian Origin, Brooklyn Pediatric Society, Midwest Society for Pediatric Research

Disclosure: Nothing to disclose.

Specialty Editor Board

Mary L Windle, PharmD Adjunct Associate Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Nothing to disclose.

Brian S Carter, MD, FAAP Professor of Pediatrics, University of Missouri-Kansas City School of Medicine; Attending Physician, Division of Neonatology, Children's Mercy Hospital and Clinics; Faculty, Children's Mercy Bioethics Center

Brian S Carter, MD, FAAP is a member of the following medical societies: Alpha Omega Alpha, American Academy of Hospice and Palliative Medicine, American Academy of Pediatrics, American Pediatric Society, American Society for Bioethics and Humanities, American Society of Law, Medicine & Ethics, Society for Pediatric Research, National Hospice and Palliative Care Organization

Disclosure: Nothing to disclose.

Chief Editor

Muhammad Aslam, MD Professor of Pediatrics, University of California, Irvine, School of Medicine; Neonatologist, Division of Newborn Medicine, Department of Pediatrics, UC Irvine Medical Center

Muhammad Aslam, MD is a member of the following medical societies: American Academy of Pediatrics

Disclosure: Nothing to disclose.