Surfactant (beractant/poractant)

Overview

Exogenous surfactant instilled into the lungs of preterm neonates with (or at risk of) respiratory distress syndrome from surfactant deficiency.

Mechanism

Replaces deficient endogenous pulmonary surfactant (the phospholipid–protein film made by type-II pneumocytes) → lowers alveolar surface tension → prevents end-expiratory alveolar collapse, improves compliance and oxygenation. Antenatal maternal steroids reduce the need by maturing the fetal lungs.

Indications

• Neonatal respiratory distress syndrome (surfactant-deficient preterm)
• Prophylaxis in extremely preterm infants

The agents

Adverse effects

Cautions & contraindications

Interactions

• —

Monitoring & kinetics

Oxygenation, ventilation, CXR; titrate ventilator after dosing

Endotracheal instillation (via ETT), often with INSURE / LISA technique.