Dose and Administration

1. Curosurf 1.25ml/kg (100mg/kg phospholipid) via endotracheal tube, ⁴ administered by a doctor/NS-ANP.
   Some infants with severe RDS may receive 2.5ml/kg (200mg/kg phospholipid) ⁴  on the instruction of specialist.
   • Inject as a single bolus directly into ETT. ⁵
   • Administer rapidly as quickly as the baby tolerates it.
   • Baby supine and flat throughout.
2. Subsequent doses should not be given less than 6 hours after the preceding dose.
   The usual criteria for administering a second dose are:
   • need for positive pressure ventilation, and
   • FiO₂ >0.30
3. Some infants may require more than 2 doses.  This should be on the instruction of a specialist.

Indications

1. Respiratory Distress Syndrome in preterm infants.
   • See Guideline on Exogenous Surfactant
2. Other conditions with presumed surfactant deficiency (discuss with specialist first)

Contraindications and Precautions

1. Use in infants weighing <700g is not established.
2. Efficacy of poractant in the treatment of Meconium Aspiration Syndrome and Group B Streptococcal Pneumonia has not been proven.

Clinical Pharmacology

A natural porcine surfactant derived from minced pig lungs.  Surfactant is extracted using chloroform or methanol and then purified using liquid-gel chromatography.  It is then sterilised via a high pressure filter system and then finally suspended in an isotonic saline solution to a final concentration of 80mg/ml phospholipids.  It also contains surfactant apoproteins SP-B and SP-C.

Poractant increases the degree of mechanical stability of the alveoli and reduces surface tension.  A surfactant monolayer is formed at the air-liquid interface, allowing all areas of lung to expand and contract.

Poractant is absorbed extremely rapidly.  Infants typically show a rapid improvement in oxygenation within minutes of the dose.

Possible Adverse Effects

1. Instability during administration.
2. Possible ETT blockage.
3. Rapid changes in lung compliance and blood gases.
4. Slight increased risk of pulmonary haemorrhage.
5. Increased risk of nosocomial infections.

Special Considerations

1. Should be used after consultation with specialist.
2. Staff need to be careful with vial size selection, as inappropriate vial selection may result in high wastage and therefore increased cost.
   Use the table below as a guide for choosing vial size:
   

   Infant weight	1 dose (100mg/kg) expected	2 doses (200mg/kg total) expected
   	Vial size	Vial size
   ≤600g	1.5ml	1.5ml
   600g-1200g	1.5ml	3ml
   1200g-1800g	3ml	3ml plus 1.5ml
   >1800g	3ml	3ml plus 3ml

   • These are guidelines only and discretion may be needed around choosing an appropriate vial size for a particular infant.

3. Monitor O₂ saturation, ECG continuously and blood gases and adjust ventilator/oxygen appropriately.
4. Suction prior to administration if necessary but avoid suctioning if possible for 6 hours following doses.
5. Jewish and Muslim parents:  use in these populations should be discussed with parents.  Poractant has been used extensively in Israel and as it is not per se ingested, its use is considered acceptable.  Parents should be informed that alternative non-porcine preparations are not immediately available.