Results
INDICATIONS
- Prophylaxis: Prophylaxis of infants at high risk for RDS (those less than 29 weeks gestation).
- Rescue: Rescue treatment of infants with moderate to severe RDS.
- Treatment of mature infants with respiratory failuredue to meconium aspiration syndrome, pneumonia, or persistent pulmonary hypertension.
ADVERSE EFFECTS
Administration of exogenous surfactants should be restricted to highly supervised clinical settings, with immediate availability of clinicians experienced with intubation, ventilator management, and general care of premature infants. Reflux of exogenous surfactant up the ET tube and falls in oxygenation occur frequently. If the infant becomes dusky or agitated, heart rate slows, oxygen saturation falls more than 15%, or surfactant backs up in the ET tube, dosing should be slowed or halted. If necessary, ventilator settings and/or FiO2 should be turned up. Pulmonary hemorrhage occurs in 2% to 4% of treated infants, primarily the smallest patients with untreated PDA. This may be due to hemorrhagic pulmonary edema caused by the rapid fall in pulmonary vascular resistance and resulting increased pulmonary blood flow.
MONITORING
Assess ET tube patency and position. Oxygen saturation, EKG, and blood pressure should be monitored continuously during dosing. Assess for impairment of gas exchange caused by blockage of the airway. After dosing, frequent assessments of oxygenation and ventilation should be performed to prevent postdose hyperoxia, hypocarbia, and overventilation.