A modified bovine pulmonary surfactant called beractant (survanta) lowers the surface tension between the air and alveolar surfaces.

When preterm infants have a birth weight of less than 1,250 g or show signs of surfactant insufficiency, it is used to treat and prevent respiratory distress syndrome. It should be administered within 15 minutes of birth. Neonates who develop respiratory distress syndrome and require mechanical ventilation and those with a radiologically confirmed RDS should be administered beractant within eight hours of birth.

Beractant Dose in Adults

Not indicated

Beractant Dose in Children

Beractant Dose in the treatment of Respiratory distress:  

Beractant is a medicine used to help premature babies with a breathing problem called respiratory distress syndrome (RDS).

For really tiny babies weighing less than 600 grams or more than 1,750 grams, here's how it's given:

• Preventive Treatment: Right after birth, doctors put 4 milliliters of beractant for every kilogram the baby weighs into a tube that goes into their lungs. They try to do this within 15 minutes of birth. They might give up to 4 doses in the first 48 hours of life, but not more than every 6 hours. Usually, they don't give it more often than every 12 hours, unless the baby's breathing trouble gets worse because of an infection, poop, or blood in the lungs.
• Rescue Treatment: If doctors find out the baby has RDS after birth, they also use 4 milliliters per kilogram of beractant right away. They might give more doses every 6 hours, but not more than 4 doses in the first 48 hours, unless the baby's breathing gets worse because of infection, poop, or blood in the lungs.

In both cases, doctors decide if the baby needs more doses based on how much oxygen the baby needs to breathe properly. If the baby still needs a lot of oxygen, they might give more beractant.

Use during pregnancy and breastfeeding: Not applicable here

• Beractant is a medicine meant for premature babies.
• It helps with a breathing problem they might have called respiratory distress syndrome (RDS).
• It's not used for adults or older children, only for tiny babies born too early.

Beractant Dose in Renal Disease:

• The manufacturer hasn't suggested changing the dose of beractant for people with kidney problems.

Beractant Dose in Liver Disease:

• The manufacturer hasn't suggested changing the dose of beractant for people with liver issues.

Common Side Effects of Beractant Include:

• Cardiovascular:
  • Transient Bradycardia

Less Common Side Effects of Beractant Include:

• Respiratory:
  • Oxygen desaturation

Contraindications to Beractant include:

• The manufacturer's label doesn't mention any reasons why someone shouldn't use beractant.

Warnings and Precautions

Mucous plugs:

• If a baby has trouble breathing a lot right after getting beractant, it could be because mucus has blocked the tube that goes into their lungs.
• Doctors may suction out any mucus before giving the medicine to lower the chance of this happening.
• If the tube stays blocked even after suctioning, doctors will quickly replace it to help the baby breathe properly.

Nosocomial sepsis:

• Transient adverse effects: Transient episodes of bradycardia and decreased oxygen saturation may occur.
• Discontinue dosing procedure and initiate measures to alleviate the condition; may reinstitute after the patient is stable.
• Rales and moist breath sounds may occur; endotracheal suctioning or other remedial action is necessary if clear-cut signs of airway obstruction are present.

Transient adverse effects:

• Sometimes, after getting beractant, premature babies might experience temporary drops in their heart rate (called bradycardia) or their oxygen levels (called decreased oxygen saturation).
• If this happens, doctors will stop giving the medicine and take steps to help the baby feel better.
• They might restart the treatment once the baby is stable.
• Additionally, the baby might have rattling sounds in their chest (called rales) or wet breath sounds.
• If it's clear that the airway is blocked, doctors will need to suction out the tube or take other actions to help the baby breathe better.

Beractant: Drug Interaction

Note: Drug Interaction Categories:

• Risk Factor C: Monitor When Using Combination
• Risk Factor D: Consider Treatment Modification
• Risk Factor X: Avoid Concomitant Use

Monitor:

Monitoring during Administration:

• Continuous ECG Monitoring: Doctors will keep a close eye on the baby's heart rate using a machine called an ECG.
• Oxygen and Carbon Dioxide Levels: They'll also check how much oxygen and carbon dioxide are in the baby's blood using a special machine that can be attached to the skin or by drawing blood from an artery.
• Arterial Blood Gases: Sometimes, they might take a small amount of blood from the baby's artery to check how well their lungs are working and how much oxygen and carbon dioxide are in their blood.

How to administer Beractant?  

Endotracheal/Intratracheal Administration:

• Preparation: Let beractant sit at room temperature for 20 minutes or warm it in your hand for at least 8 minutes before giving it. Don't use any artificial warming methods. Check the solution to make sure it's mixed well; don't shake it. If it settles during storage, gently swirl it. Suction the baby before giving the medicine.
• Endotracheal Administration:
  • Equipment: Use a 5-French end-hole catheter.
  • Procedure: Make sure the baby is stable. Insert the catheter into the endotracheal tube. Give the dose in four parts, each part being 1 mL/kg. Each quarter of the dose is given over 2 to 3 seconds, followed by at least 30 seconds of manual ventilation or until the baby is stable. Each quarter-dose is given with the baby in a different position: slightly downward with the head turned right, then left; then slightly upward with the head turned right, then left. After giving the full dose, don't suction the baby for 1 hour unless there are signs of serious airway blockage.
• Intratracheal Administration:
  • Method: For babies who are breathing on their own and don't need a tube in their throat, a method called minimally invasive surfactant therapy (MIST) is used. Limited data is available.
  • Procedure: Use a thin catheter (2.5- to 5-French) placed between the vocal cords under direct laryngoscopy. Administer the surfactant dose over 1 to 3 minutes. In some cases, doctors use a medicine called atropine before the procedure (Kribs 2007).

Mechanism of action of Beractant:

• Beractant is used to replace or supplement the natural lung surfactant in newborns who have a condition called respiratory distress syndrome (RDS), or who are at risk of getting it.
• This medicine helps prevent the tiny air sacs in the lungs (called alveoli) from collapsing when the baby breathes out.
• It does this by reducing the tension between the air and the surface of the alveoli.

Onset of action:

• Beractant starts working quickly to improve oxygen levels in the baby's blood.
• Within just a few minutes of being given, it can help the baby breathe better and get more oxygen into their body.

International Brands of Beractant:

• Surfacten
• Survanta
• Survanta-Vent

Beractant Brands in Pakistan: