SURFACTAN THERAPY FOR NEONATES

Andi Rismawaty Darma Neonatologi Division

INTRODUCTION
Surfactan is a material complex covering the

entire lungs alveolar contain heterogen phospolipid layers produce liquid phospolipid layers decrease surface tension between air-water keep the alveolar open during respiration cycle and maintain the lung residual volume on the end of expiration

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

THE FUNCTION OF SURFACTAN

The lung tension surface is lower than normal biological liquid The surface tension is more important than tissue elasticity 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

COMPOSITION OF LUNG SURFACTAN

The lung surfactan is a lipoprotein complex

sintetized type 2 alveolar cell & clara cell in epithelial layer of respiration tract Saturation of phospolipid decrease surface tension air and water in alveolar avoid the collapsed of respiration tract while expirated.

 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 proteinsurfaktan specific, and the rest is protein from plasma or lung tissue

SURFACTAN SECRETION & SINTETHIC

The lung surfactan is sinthese in the type 2 alveolar cell, one of the cell inside alveolar ephitelial The phospolipid of surfactan is covered by protein B and C surfactan inside the lamelar bodies secrete in air space by exocitose way

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

 Indication for surfactan therapy by

oxygenation criteria: 1. FiO2>0,35 and PaO2 60-80mmHg or SpO2 88-93% 2. Arterial/alveolar oxygen tension ratio, PaO2/PaO2 (a/A ratio)<0,22

TYPES OF SURFACTAN
Natural / real surfactan made from human, amnion fluid during sectio sesaria from mother with term pregnancy Exogen Surfactan made from sinthetic, semi-sinthetic and biological exogenic

Type Survanta Surfactant TA Alveofact

Origin Bovine mince Bovine lavage

Dose 4 mL (100 lung DPPC, tripalmitin mg)/kg, Refrigerate SP (B<0.5%,> 1-4 doses q6h lung 99% PL, 1% SP-B 45 mg/mL and SP-C lung 75% PC and 1% SP-B and SP-C Federal Republic of Germany Canadian

Composition

bLES (bovine Bovine lipid extract lavage surfaktan) Infasurf

Calf lung lavage

DPPC, 3 mL (105 tripalmitin, 6 mL vials, mg)/kg, SP (B290 g/mL, refrigerate 1-4 doses, q6-12h C360 g/mL)

Calf lung surfactant Infasurf extract (CLSE) Curosurf Minced pig lung

Exosurf

Synthetic

2.5 mL (200 DPPC, mg)/kg SP-B and SP-C 1.5 and 3 mL 1.25 mL (100 (?amount) mg)/kg 85% DPPC, 9% 5 mL (67.5 Lyophilized; hexadecanol, mg)/kg, dissolve in 8 Ml 6% tyloxapol 1-4 doses, q12h
DPPC, synthetic peptide 70% DPPC, 30% unsaturated Possibly discontinued

Surfaxan (KL4) ALEC

Synthetic

Synthetic

Surfactan Dose
Each surfactan has different dose: ALEC (Pumactant): 100 mg(1,2 ml) repeat after 1 and 24 hour Curosurf ( Poractant): 100 mg (1,25 ml/kg). Repeat dose can be given after 12 and 24 hour (Colfosceril): 67,5mg/kg(5 ml)/kg) Repeat dose can be given after 12 and 24 hour Survanta (Beractant):100mg/kg(4 ml/kg) repeated every 6 hour up to 4 doses(4)

How To Use

Surfactan is single dose, use in supine position, the head is stright, little extension

After 1st dose, use ventilation 60x/mnt, O2 consentration 100% before the next dose. Ventilation in 30 second or until the baby becomes stable.

Divide the dose into 4, dose is given wihth different position. ventilator is 60x/mnt, inspiration time 0,5 second, and FiO2 1,0. ETT is released from the ventilator the head n body is lean to to the right 510, insert the surfactan first dose by NGT during 2-3 sec, than take NGT off n do the manual ventilation for 30 mnt.(4,5)

SUMMARY
Based on many researches, surfactant is an important therapy in reducing mortality and morbidity of premature infants. Prophylactic surfactant is when therapy is given as the first aid in premature neonates via ETT. Until now there is still disagreement about the timing of surfactant, whether immediately after birth (in premature infants) or after the symptoms of Respiratory Distress Syndrome arise. The rationale advanced in relation with the provision of prophylaxis associated with lung epithelium in preterm infants will be damaged within a few minutes after administration of ventilation. Respiratory Distress Syndrome (hyaline membrane disease) is the most common cause of morbidity and mortality in preterm infants. This is due to the deficiency of surfactant keeping alveolar bag growing and filled with air, resulting in premature infants in which the surfactant is still underdeveloped cause less lung tension and the baby will have asphyxia. Giving surfactant is a routine therapy in preterm infants with RDS.

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