Pulmonary surfactant (medication)

Pulmonary surfactant

Beractant, surrounded by devices for its application.
Clinical data
Pronunciation	Curosurf, Survanta, others
AHFS/Drugs.com	Monograph
ATC code	R07AA (WHO)
Identifiers
Synonyms	Beractant, Poractant alfa, others
ChemSpider	none

Pulmonary surfactant is used as a medication to treat and prevent respiratory distress syndrome in newborn babies. Prevention is generally done in babies born less than 32 weeks gestational age. It is given by the endotracheal tube.^[1] Onset of effects is rapid.^[2] A number of doses may be needed.^[2]

Side effects may include slow heart rate and low oxygen levels. Its use is also linked with intracranial bleeding.^[1] Pulmonary surfactant may be isolated from the lungs of cows or pigs or made artificially.^[1][3][4]

Pulmonary surfactant was discovered in the 1950s and a manufactured version was approved for medical use in the United States in 1990.^[3] It is on the World Health Organization's List of Essential Medicines, the most effective and safe medicines needed in a health system.^[5] In the United Kingdom it costs the NHS 281.64 to 547.40 pounds per dose.^[1]

Medical uses

Pulmonary surfactant is used to treat and prevent respiratory distress syndrome in newborn babies.^[1] Prevention is generally done in babies born less than 32 weeks gestational age.^[1] Tentative evidence supports use in drowning.^[6]

Types

There are a number of types of pulmonary surfactants avaliable.

Synthetic pulmonary surfactants

1. Colfosceril palmitate (Exosurf) - a mixture of DPPC with hexadecanol and tyloxapol added as spreading agents
2. Pumactant (Artificial Lung Expanding Compound or ALEC) - a mixture of DPPC and PG
3. KL-4 - composed of DPPC, palmitoyl-oleoyl phosphatidylglycerol, and palmitic acid, combined with a 21 amino acid synthetic peptide that mimics the structural characteristics of SP-B.
4. Venticute - DPPC, PG, palmitic acid and recombinant SP-C

Animal derived surfactants

1. Beractant
   1. (Alveofact) - extracted from cow lung lavage fluid
   2. (Survanta) - extracted from minced cow lung with additional DPPC, palmitic acid and tripalmitin
2. Calfactant (Infasurf) - extracted from calf lung lavage fluid
3. Poractant alfa (Curosurf) - extracted from material derived from minced pig lung

History

Researcher John Clements identified surfactants and their role in the 1950s. Mary Ellen Avery soon after showed that the lungs of premature infants couldn't produce surfactants.^[7]

Exosurf, Curosurf, Infasurf, and Survanta were the initial surfactants FDA approved for use in the U.S.^[8]

In 2012 the US FDA approved an additional synthetic surfactant, lucinactant (Surfaxin).

References

1. 1 2 3 4 5 6 British national formulary : BNF 69 (69 ed.). British Medical Association. 2015. p. 217. ISBN 9780857111562. 
2. 1 2 Fanaroff, Avroy A.; Fanaroff, Jonathan M. (2013). Klaus and Fanaroff's Care of the High-Risk Neonate, Expert Consult - Online and Print,6: Klaus and Fanaroff's Care of the High-Risk Neonate. Elsevier Health Sciences. p. 252. ISBN 1416040013. 
3. 1 2 Lantos, John D.; Meadow, William L. (2006). Neonatal Bioethics: The Moral Challenges of Medical Innovation. JHU Press. pp. 54–56. ISBN 9780801883446. 
4. ↑ Slonim, Anthony D.; Pollack, Murray M. (2006). Pediatric Critical Care Medicine. Lippincott Williams & Wilkins. pp. 724–725. ISBN 9780781794695. 
5. ↑ "WHO Model List of Essential Medicines (19th List)" (PDF). World Health Organization. April 2015. Retrieved 8 December 2016. 
6. ↑ Brady, Bill; Charlton, Nathan P.; Lawner, Benjamin J.; Sutherland, Sara F. (2012). Cardiac Arrest, An Issue of Emergency Medicine Clinics. Elsevier Health Sciences. p. 175. ISBN 1455742767. 
7. ↑ Palca, Joe (3 August 2015). "How A Scientist's Slick Discovery Helped Save Preemies' Lives". NPR. Retrieved 3 August 2015. 
8. ↑ Taeusch, H William; Lu, Karen; Ramierez-Schrempp, Daniela (2002). "Improving pulmonary surfactants" (PDF). Acta Pharmacologica Sinica. 23 Suppl: 11–5.