Surfactant in the NICU

Surfactant in the NICU

Curosurf

• Curosurf is an extract of natural porcine lung surfactant
• Suggest Curosurf for infants
  • Who havent received Curosurf and the respiratory status seems to be worsening
  • MD wants to add more PIP to surfactant deficient lungs
    • The addition of a PIP may cause a pneumothorax in surfactant deficient lungs.Infant should be given Curosurf before PIP is added
• Can be given every 12 hours for a total of 3 doses
• Clinical indication
  • Rescue treatment of Respiratory Distress Syndrome (RDS) in premature infants
• Initial dose and subsequent doses
  • The initial dose is 2.5/kg
  • Subsequent doses 2 and 3 are 1.25/kg
• The first indication that Curosurf may need to be administered
  • If an infant is admitted to the NICU and placed on BCPAP 7 is an increase of oxygen >40%

Preparation

• The nurse will remove the vials from the Omnicell
• Verify the dosage with the nurse
• Slowly warm the vial to room temperature
• Gently turn the vial upside down in order to obtain a uniform suspension of the liquid

Administration

• If needed suction the infants ETT before administration
• Remove the rubber stopper from the vial and draw up the ordered dose in a syringe
• Carefully remove the original ETT adapter and replace with the same size side-port ETT adapter
• While continuing ventilation, slowly administer the Curosurf
• During the administration the infant is positioned midline supine
• Infant should be on a ventilator during the administration. If a ventilator is not available then a Neopuff with set PIP and PEEP should be used
• If during the administration, the heart rate decreases, desaturations occur and Curosurf is seen coming back up the ETT
  • Stop the dosing procedure
  • Increase the FIO2
  • Allow the infant to recover
  • Try to avoid increasing PIP and the PEEP, to avoid a pneumothorax
  • When the infant is stable continue with the dosing

Following the administration of Curosurf

• The infants vital signs and lung compliance should be closely monitored for 15 minutes after dosing
• Adverse reactions
  • Apnea
  • Bradycardia
  • Cyanosis
  • Hypoxia
  • Pulmonary Hemorrhage
  • Desaturation
  • Endotracheal tube blockage
  • An increase in intracranial pressure
• Suctioning has to wait
  • At least one hour
  • If possible try not to suctioning unless clinically indicated
• If following a dose of curosurf, a patient on BCPAP is able to wean Fio2 significantly you should inform the MD/NNP of the FIO2 and decrease the BCPAP
• Curosurf improves lung compliance quickly and a failure to wean the BCPAP pressure can result in a pneumothorax