Pulmonary surfactant (medication)

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Pulmonary surfactant
Pulmonary surfactant.JPG
Beractant, surrounded by devices for its application.
Clinical data
PronunciationCurosurf, Survanta, others
SynonymsBeractant, Poractant alfa, others
AHFS/Drugs.comMonograph
ATC code
Identifiers
ChemSpider
  • none

Pulmonary surfactant is used as a medication to treat and prevent respiratory distress syndrome in newborn babies.[1] Prevention is generally done in babies born less than 32 weeks gestational age.[1] It is given by the endotracheal tube.[1] Onset of effects is rapid.[2] A number of doses may be needed.[2]

Side effects may include slow heart rate and low oxygen levels.[1] Its use is also linked with intracranial bleeding.[1] Pulmonary surfactant may be isolated from the lungs of cows or pigs or made artificially.[1][3][4]

Pulmonary surfactant was discovered in the 1950s and a manufactured version was approved for medical use in the United States in 1990.[3] It is on the World Health Organization's List of Essential Medicines, the most effective and safe medicines needed in a health system.[5] In the United Kingdom it costs the NHS 281.64 to 547.40 pounds per dose.[1]

Medical uses[edit]

Pulmonary surfactant is used to treat and prevent respiratory distress syndrome in newborn babies.[1] Prevention is generally done in babies born less than 32 weeks gestational age.[1] Tentative evidence supports use in drowning.[6]

Types[edit]

There are a number of types of pulmonary surfactants available. Like their natural counterparts, pulmonary surfactant preparations consist of phospholipids (mainly DPPC) combined with spreading agents such as SP-B and SP-C.[7]

Synthetic pulmonary surfactants:

  • Colfosceril palmitate (Exosurf) - a mixture of DPPC with hexadecanol and tyloxapol added as spreading agents
  • Pumactant (Artificial Lung Expanding Compound or ALEC) - a mixture of DPPC and PG
  • Lucinactant (KL-4) - composed of DPPC, palmitoyl-oleoyl phosphatidylglycerol, and palmitic acid, combined with a 21 amino acid synthetic peptide (sinapultide) that mimics the C-terminal helical domain of SP-B.[8]
  • Venticute - DPPC, PG, palmitic acid and recombinant SP-C
  • Lucinactant (trade name Surfaxin) is a liquid medication that contains DPPC, POPG as the sodium salt, and palmitic acid.

Animal derived surfactants:

  • Beractant
    • (Alveofact) - extracted from cow lung lavage fluid, manufacturing by Boehringer Ingelheim
    • (Survanta) - extracted from minced cow lung with additional DPPC, palmitic acid and tripalmitin, manufacturing by Abbvie
    • (Beraksurf) - extracted from minced cow lung with additional DPPC, palmitic acid and tripalmitin, manufacturing by Tekzima
  • Calfactant (Infasurf) - extracted from calf lung lavage fluid
  • Poractant alfa (Curosurf) - extracted from material derived from minced pig lung

History[edit]

Researcher John Clements identified surfactants and their role in the 1950s. Mary Ellen Avery soon after showed that the lungs of premature infants couldn't produce surfactants.[9]

Exosurf, Curosurf, Infasurf, and Survanta were the initial surfactants FDA approved for use in the U.S.[10]

In 2012 the US FDA approved an additional synthetic surfactant, lucinactant (Surfaxin).

References[edit]

  1. ^ a b c d e f g h i British national formulary : BNF 69 (69 ed.). British Medical Association. 2015. p. 217. ISBN 9780857111562.
  2. ^ a b Fanaroff, Avroy A.; Fanaroff, Jonathan M. (2013). Klaus and Fanaroff's Care of the High-Risk Neonate, Expert Consult - Online and Print,6: Klaus and Fanaroff's Care of the High-Risk Neonate. Elsevier Health Sciences. p. 252. ISBN 1416040013. Archived from the original on 2017-01-09. Cite uses deprecated parameter |deadurl= (help)
  3. ^ a b Lantos, John D.; Meadow, William L. (2006). Neonatal Bioethics: The Moral Challenges of Medical Innovation. JHU Press. pp. 54–56. ISBN 9780801883446. Archived from the original on 2017-01-09. Cite uses deprecated parameter |deadurl= (help)
  4. ^ Slonim, Anthony D.; Pollack, Murray M. (2006). Pediatric Critical Care Medicine. Lippincott Williams & Wilkins. pp. 724–725. ISBN 9780781794695. Archived from the original on 2017-01-09. Cite uses deprecated parameter |deadurl= (help)
  5. ^ "WHO Model List of Essential Medicines (19th List)" (PDF). World Health Organization. April 2015. Archived (PDF) from the original on 13 December 2016. Retrieved 8 December 2016. Cite uses deprecated parameter |deadurl= (help)
  6. ^ Brady, Bill; Charlton, Nathan P.; Lawner, Benjamin J.; Sutherland, Sara F. (2012). Cardiac Arrest, An Issue of Emergency Medicine Clinics. Elsevier Health Sciences. p. 175. ISBN 1455742767. Archived from the original on 2017-01-09. Cite uses deprecated parameter |deadurl= (help)
  7. ^ Nkadi, Paul O.; Merritt, T. Allen; Pillers, De-Ann M. (2009). "An overview of pulmonary surfactant in the neonate: Genetics, metabolism, and the role of surfactant in health and disease". Molecular Genetics and Metabolism. 97 (2): 95–101. doi:10.1016/j.ymgme.2009.01.015. ISSN 1096-7192. PMC 2880575.
  8. ^ "KL4 Surfactant Technology - Windtree Therapeutics, Inc". Windtree Therapeutics, Inc. Archived from the original on July 29, 2018. Retrieved 29 November 2017. Cite uses deprecated parameter |dead-url= (help)
  9. ^ Palca, Joe (3 August 2015). "How A Scientist's Slick Discovery Helped Save Preemies' Lives". NPR. Archived from the original on 3 August 2015. Retrieved 3 August 2015. Cite uses deprecated parameter |deadurl= (help)
  10. ^ Taeusch, H William; Lu, Karen; Ramierez-Schrempp, Daniela (2002). "Improving pulmonary surfactants" (PDF). Acta Pharmacologica Sinica. 23 Suppl: 11–5. Archived (PDF) from the original on 2015-03-01. Cite uses deprecated parameter |deadurl= (help)