Page 585 - Clinical Application of Mechanical Ventilation

Neonatal Mechanical Ventilation 551

TABLE 17-4 Recommended Dosages of Common Surfactants

Type of Surfactant dosage

Synthetic
Surfaxin (lucinactant) 5.8 mL/kg
(Up to 4 total doses in the first 48 hours of life; any 2 doses
given at least 6 hours apart.
Natural
(A) Bovine (Survanta®, Infasurf®, Survanta® 5 4 mL/kg every 6 hours up to 4 total doses in
Alveofact®) the first 48 hours.
Infasurf®: 3 mL/kg every 6 hours up to 4 doses.

(B) Porcine (Curosurf®) Initial dose 5 2.5 mL/kg.
Up to 2 additional doses at 1.25 mL/kg every 12-hour.
Maximum of repeat doses not to exceed 5 mL/kg
combined.
(Divide each dose into two halves and give these halves
doses 30 sec apart.)
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Outcomes

On the positive side, surfactant replacement therapy appears to reduce the se-
verity of RDS, pulmonary interstitial emphysema (PIE), and epithelial necro-
sis (Pinar et al., 1994), reduces pulmonary vascular resistance (Kaapa et al.,
1993), improves lung function (Yuksel et al., 1993), and has beneficial long-
term effects on airway resistance (Abbasi et al., 1993). Additionally, synthetic
surfactants such as the discontinued Exosurf may reduce the incidence of
bronchopulmonary dysplasia (BPD) and intraventricular hemorrhage (IVH)
(Long, 1993).
Another study found that surfactant replacement therapy may have an impact
Surfactant replacement on cerebral perfusion, most likely due to direct pulmonary or hemodynamic
therapy reduces the severity
of RDS and the incidence of changes (or a combination of both) (Hentschel et al., 2002). Surfactant re-
some related cardiopulmo- placement does not work on all patients. It is not known why some patients
nary complications.
have a transient response and others have no response. Perhaps as knowledge
and understanding continue to advance in this area, we will discover those un-
known factors that prevent successful use of surfactant replacement therapy in
all neonates.
Since coming of age, surfactant replacement therapy has dramatically decreased
the mortality rate from RDS in neonates. It should now be considered the stan-
dard of care for those neonates with RDS who require mechanical ventilation
(Ramanathan, 2006).

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