Curosurf (Poractant alfa) is a surfactant that reduces the surface tension between the alveoli preventing them from collapsing. It improves gas exchange and hypoxemia and premature infants.

Curosurf (Poractant alfa) Uses:

• Respiratory distress syndrome (RDS):
  • It is indicated as a rescue treatment (in premature infants) of respiratory distress syndrome (RDS). Its use is associated with a reduction in RDS associated complications like pneumothorax and mortality.

Survanta (Beractant) is another surfactant available.  

Curosurf (Poractant alfa) Dose in Adults

It is not indicated in adults.   

Curosurf (Poractant alfa) Dose in Children

Note: For intratracheal use only

Curosurf (Poractant alfa) dose in the treatment of Respiratory distress syndrome (RDS):

• Neonates:
  • o Intratracheal:
    • 2.5 mL/kg of birth weight initially.
    • Two additional doses of 1.25 mL/kg birth weight may be administered at 12-hour intervals.
    • Infants who require mechanical ventilation and extra oxygen should receive additional dosages.
    • The highest total dose that is advised is 5 mL/kg of birth weight.

Pregnancy & Lactation

• It is not indicated for use in adults.

Poractant alfa use during breastfeeding:

• It is not indicated in adults.

Dose in Kidney Disease:

The manufacturer has not provided any adjustment in the dose.   

Dose in Liver disease:

The manufacturer has not provided any adjustments in the dose.   

Side effects of Curosurf (Poractant alfa):

• Cardiovascular:
  • Patent ductus arteriosus
  • Bradycardia
  • Hypotension
• Hematologic & oncologic:
  • Oxygen desaturation
• Miscellaneous:
  • Obstruction of the endotracheal tube

Contraindications to Curosurf (Poractant alfa):

Allergy reactions to any component of the drug or the drug itself

Warnings and precautions

• Pulmonary hemorhage
  • Pulmonary hemorhage is a risk for preterm babies and infants born at low birth weight.
  • Poractant alfa has been shown to cause pulmonary hemorhage in infants.
• Transient adverse effects:
  • Administration of it may cause transient bradycardia or hypotension, hypoxemia, or blockage the endotracheal tube.
  • Temporarily stop using the drug and then treat the infant as usual.
  • Once the baby is stable, you can reintroduce treatment.

Poractant alfa: Drug Interaction

Monitoring parameters:

Monitor ABGs (Arterial blood gases)  and ventilatory status.   

How to administer Curosurf (Poractant alfa)?

Administration Protocol:

Endotracheal and Intratracheal administration:

• The injection should be kept at room temperature t warm.
• Prior to administration, inspect the injection. It should look white or creamy white.
• Mix the contents of the vial by gently moving the injection upside down to get a uniform suspension. Avoid vigorous shaking of the injection.
• Withdraw the whole content into a 3 ml or 5 ml syringe slowly using a 20 gauge needle or more.
• The excess dose should be discarded (only the amount to be injected should remain in the syringe).

Endotracheal:

• Ensure proper placement of the endotracheal tube.
• Assess the patency of the endotracheal tube and clear the airways by suctioning.
• To avoid interrupting mechanical ventilation, administer the drug via a 5-French end-hole catheter (of 8 cm) through the secondary lumen of the double-lumen endotracheal tube.

Administration using a 5-French end-hole catheter:

• Before administering the drug, ensure the infant is stable.
• Keep the infant's head and torso in line with the left or right side, depending (and without inclination).
• Set the ventilator to a different setting before giving the medication as:
• • supplemental oxygen to maintain SaO2 of 92% or more.
  • inspiratory time 0.5 seconds
  • a Respiratory rate of 40 to 60 breaths/minute
• Insert the 5-French catheter after briefly removing the ventilator's connection to the endotracheal tube.
• Divide the surfactant dose into two equal aliquots and administer each one.
• For the initial dose, administer the first aliquot at a dose of 1.25 mL/kg birth weight, and for subsequent doses, at 0.635 mL/kg birth weight.
• After that, remove the catheter right away and manually ventilate the child for one minute at a rate of 40 to 60 breaths per minute while providing 100% oxygen.
• When the baby is stable after a minute, switch to the other side so that the other side of the baby gets reliant.
• The remaining aliquot should be given using the same method (1.25 mL/kg birth weight for the first dosage and 0.635 mL/kg birth weight for subsequent doses).
• Avoid suctioning of the airways for one hour after the administration of the drug (except in infants with signs of significant airway obstruction.
• Resume clinical care and ventilator management.

Administration using the secondary lumen of a dual-lumen endotracheal tube (without using the catheter):

• Make sure the infant is stable before administering the dose.
• Keep the body and the head in alignment before the administration of the drug.
• Administer poractant alfa through the proximal end of the second lumen slowly over one minute without interrupting the mechanical ventilation.
• Avoid suctioning of the airways for one hour after the administration of the drug except in severe obstruction.
• Ventilator settings may need to be modified for a short time to avoid hypoxemia (increase in FiO2, respiratory rate, and peak inspiratory pressure)

Administration of poractant alfa in infants who do not require mechanical ventilation (spontaneously breathing):

• Minimally Invasive Surfactant Therapy (MIST):
  • The drug may be administered using a thin catheter (2.5- to 5-French).
  • Under direct laryngoscopy, place the catheter between the vocal cords and administer the dose over one to three minutes.
  • Premedication with atropine may be used.

Mechanism of action of Curosurf (Poractant alfa):

• It is an inborn pulmonary surfactant that lowers surface tension at the air-liquid interface of alveoli during respiration.
• It prevents the alveoli from collapsing at resting transpulmonary pressures. 
• It can cause respiratory distress syndrome in preterm infants.
• Preterm infants with respiratory distress syndrome are susceptible to atelectasis, which results in inadequate gas exchange and poor lung expansion.
• Poractant alfa is a natural surfactant that is used in infants.
• It prevents the lungs from collapsing, reduces mortality, and helps to manage the respiratory distress syndrome.   

International Brands of Poractant alfa:

• Curosurf

Poractant alfa Brand Names in Pakistan:

No Brands Available in Pakistan.