Surfactan Therapy for Neonates

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SURFACTAN THERAPY

FOR NEONATES

Andi Rismawaty Darma

Neonatologi Division


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INTRODUCTION

Surfactan is a material complex covering the

entire lungs alveolar contain heterogenphospolipid layers produce liquidphospolipid layers decrease surfacetension between air-water keep thealveolar open during respiration cycle and

maintain the lung residual volume on the endof expiration


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DEFENITION

Surfactan is made from type-II alveoli cell

It grows on 22-24 week gestation

It active on 24-26 week gestation It start to function on 32-36 week gestation

Its controlled by cortisol by its receptors from

type 2 alveoli cell


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THE FUNCTION OF SURFACTAN

The lung tension surface is lower than normalbiological liquid

The surface tension is more important than tissueelasticity strength of lung while expanded

Sufactan leakage accumulation of liquid in

alveolar space

It also can increase clearance of mucocillier &eliminate the foreign particulates from the lungs


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COMPOSITION OF LUNG SURFACTAN

The lung surfactan is a lipoprotein complexsintetized type 2 alveolar cell & clara cell inepithelial layer of respiration tract

Saturation of phospolipid decrease surfacetension air and water in alveolar avoid thecollapsed of respiration tract while expirated.


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It contains 90% lipid and 10% protein

In human, phosphatidylcholine consist of

almost 80% total lipid, half

dipalmitoylphosphatidylcholine (DPPC), 8%

neuthral lipid, and 12% protein protein-surfaktan specific, and the rest is protein from

plasma or lung tissue


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SURFACTAN SECRETION & SINTETHIC

The lung surfactan is sinthese in the type 2

alveolar cell, one of the cell inside alveolarephitelial

The phospolipid of surfactan is covered byprotein B and C surfactan inside the lamelarbodies secrete in air space by exocitose way


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INDICATIONS

Respiratory Distress of the newborn / RDN(surfactant rescue therapy)

Given in < 34 week gestation

They need to fulfill the criteria diagnose for RDN by

clinical signs and imaging

It use trachea intubation and ventilation


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Indication for surfactan therapy byoxygenation criteria:

1. FiO2>0,35 and PaO2 60-80mmHg or SpO288-93%

2. Arterial/alveolar oxygen tension ratio,

PaO2/PaO2 (a/A ratio)


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TYPES OF SURFACTAN

Natural / real surfactanmade from

human, amnion fluid during sectio sesariafrom mother with term pregnancy

Exogen Surfactanmade from sinthetic,semi-sinthetic and biological exogenic

T O i i C i i D


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Type Origin Composition DoseSurvanta

Bovine lung

minceDPPC, tripalmitin

SP (B4 mL (100

mg)/kg,

1-4 doses q6hRefrigerate

Surfactant TAAlveofact Bovine lung

lavage99% PL, 1% SP-B

and SP-C 45 mg/mLFederal Republic

of GermanybLES (bovine

lipid extract

surfaktan)Bovine lung

lavage75% PC and 1%

SP-B and SP-C Canadian

Infasurf Calf lung lavageDPPC,

tripalmitin,

SP (B290 g/mL,

C360 g/mL)

3 mL (105

mg)/kg,

1-4 doses, q6-12h6 mL vials,

refrigerateCalf lung

surfactant

extract (CLSE)Infasurf

Curosurf Minced pig lungDPPC,

SP-B and SP-C

(?amount)

2.5 mL (200

mg)/kg

1.25 mL (100

mg)/kg1.5 and 3 mL

Exosurf Synthetic85% DPPC, 9%

hexadecanol,

6% tyloxapol5 mL (67.5

mg)/kg,

1-4 doses, q12hLyophilized;

dissolve in 8 MlSurfaxan (KL4) Synthetic DPPC, syntheticpeptideALEC Synthetic 70% DPPC,30% unsaturated Possibly

discontinued


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Surfactan Dose

Each surfactan has different dose:

ALEC (Pumactant): 100 mg(1,2 ml) repeatafter 1 and 24 hour

Curosurf ( Poractant): 100 mg (1,25 ml/kg).Repeat dose can be given after 12 and 24hour

(Colfosceril): 67,5mg/kg(5 ml)/kg) Repeatdose can be given after 12 and 24 hour

Survanta (Beractant):100mg/kg(4 ml/kg)repeated every 6 hour up to 4 doses(4)


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How To Use

Surfactan is single dose, use in supine

position, the head is stright, little extension

After 1st dose, use ventilation 60x/mnt, O2consentration 100% before the next dose.Ventilation in 30 second or until the babybecomes stable.


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Divide the dose into 4, dose is givenwihth different position. ventilator is60x/mnt, inspiration time 0,5 second, andFiO2 1,0. ETT is released from the ventilator the head n body is lean to to the right 5-

10, insert the surfactan first dose byNGT during 2-3 sec, than take NGT off n dothe manual ventilation for 30 mnt.(4,5)


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SUMMARY

Based on many researches, surfactant is an important therapy in

reducing mortality and morbidity of premature infants. Prophylacticsurfactant is when therapy is given as the first aid in prematureneonates via ETT. Until now there is still disagreement about thetiming of surfactant, whether immediately after birth (in prematureinfants) or after the symptoms of Respiratory Distress Syndromearise. The rationale advanced in relation with the provision of

prophylaxis associated with lung epithelium in preterm infants will bedamaged within a few minutes after administration of ventilation.Respiratory Distress Syndrome (hyaline membrane disease) is themost common cause of morbidity and mortality in preterm infants.This is due to the deficiency of surfactant keeping alveolar baggrowing and filled with air, resulting in premature infants in whichthe surfactant is still underdeveloped cause less lung tension and thebaby will have asphyxia. Giving surfactant is a routine therapy inpreterm infants with RDS.


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THANKYOU

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Surfactan Therapy for Neonates

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