Beractant (survanta) for Respiratory Distress Syndrome

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

Dose in the treatment of Respiratory distress:

  • Prophylactic therapy:
    • Endotracheal tube administration of 4 mL/kg (100 mg phospholipids/kg) as soon as feasible after delivery (preferably within fifteen minutes of birth)
    • As many as four doses may be administered six hours apart during the first two days of life.
    • The usual dose is administered two times a day unless it is inactivated by an infectious process, meconium or blood.
    • Additional doses may be administered if the neonate is still intubated and requires at least 30% of the fraction of inhaled oxygen.

Note:

  • Newborns who develop respiratory distress syndrome but do not require mechanical ventilation should be advised to a CPAP after birth and a selective surfactant administered.

Beractant rescue treatment:

  • 4 mL/kg (100 mg phospholipids/kg) administered via an endotracheal tube as soon as the diagnosis of Respiratory distress syndrome is made.
  • As many as four doses may be administered six hours apart during the first two days of life.
  • The usual dose is administered two times a day unless it is inactivated by an infectious process, meconium or blood.
  • Additional doses may be administered if the neonate is still intubated and requires at least 30% of the fraction of inhaled oxygen.

Use during pregnancy and breastfeeding: Not applicable here

  • Beractant is not indicated for children or adults. It is only indicated for use in premature neonates.

Beractant Dose in Renal Disease:

  • Adjustment in the dose has not been recommended by the manufacturer in patients with renal disease.

Beractant Dose in Liver Disease:

  •  Adjustment in the dose has not been recommended by the manufacturer in patients with liver disease.

Common Side Effects of Beractant Include:

  • Cardiovascular:
    • Transient Bradycardia

Less Common Side Effects of Beractant Include:

  • Respiratory:
    • Oxygen desaturation

Contraindications to Beractant include:

There are no contraindications for its use, according to the manufacturer.

Warnings and Precautions

  • Mucous plugs:
    • Mucus plugging can cause obstruction of the endotracheal tube.
    • To reduce the chance of obstruction, it is important to suction before administering the medication.
    • Tube obstructions should not be relieved by suctioning.
  • Nosocomial sepsis:
    • It has been linked to an increased risk of nosocomial Sepsis.
  • Transient adverse effects:
    • Hypoxemia and transient bradycardia can occur.
    • You should not give surfactant treatment until your patient is stable.

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

Risk Factor C (Monitor therapy).

Bradycardia-Causing Agents May increase the bradycardic effects of Bradycardia-Causing agents.
Bretylium May increase the bradycardic effects of Bradycardia Causing Agents. Patients receiving AV-blocking drugs may experience a reduction in AV blockade due to Bretylium.
Ivabradine Ivabradine's bradycardic effects may be exacerbated by substances that cause bradycardia.
Lacosamide Lacosamide's AV-blocking effects might be exacerbated by substances that cause bradycardia.
Midodrine Bradycardia Causing Agents may have more bradycardic effects.
Ruxolitinib May increase the bradycardic effects of Bradycardia-Causing Management: The Canadian product labels for ruxolitinib advise against taking as many bradycardia-inducing medications as possible.
Terlipressin Bradycardia Causing Agents may have more bradycardic effects.
Tofacitinib Bradycardia Causing Agents may have more bradycardic effects.

Risk Factor D (Consider therapy modifications)

Ceritinib Bradycardia-inducing substances may intensify the bradycardic effects of ceritinib. Management: If the combination is not achievable, keep a close eye out for bradycardia symptoms in patients and regularly follow their blood pressure and heart rate during treatment. Various monographs will go through the exceptions.
Siponimod Bradycardia-Causing Drugs can increase Siponimod's bradycardic effects. Management: Siponimod should not be taken with bradycardia-causing drugs.

Monitor:

  • Monitor ECG
  • Monitor systemic oxygen and carbon dioxide during the administration
  • Arterial blood gases

How to administer Beractant?

  • Allow the medication to warm up in your hands for at least eight minutes before delivering it, or let it rest at room temperature for twenty minutes.
  • Make sure the medicine has been thoroughly mixed by giving it a gentle whirl.
  • Never shake it.
  • Before giving the medication, do endotracheal suctioning.

Endotracheal administration: 

  • Administration using a 5-French end-hole catheter and endotracheal tube:
    • Make sure the baby is stable before giving the medication.
    • Enter the endotracheal tube with a catheter with a 5 French end-hole.
    • The dosage should be divided into four equal parts and given in four 1 mL/kg aliquots during a 2- to 3-minute period. This should be followed by 30 minutes of manual ventilation, or until the baby is stable.
    • Change the position of the infant prior to the administration of each portion.
    • Withhold suctioning for one hour after administering one full dose unless features of airway obstruction are present.
  • Intratracheal administration (MIST (minimally invasive surfactant) therapy:
    • Administer via a thin catheter (2.5 - 5 French catheter).
    • Via direct laryngoscopy, the catheter is placed between the vocal cords and the dose is administered over 1 - 3 minutes.
    • Premedication with atropine may be used.

Mechanism of action of Beractant:

  • It is used to replace the lung surfactant for neonates suffering from respiratory distress syndrome (RDS), or those at high risk of developing RDS, who are either deficient in surfactant production or deficient in it.
  • Surfactant reduces the tension between air and alveolar surfaces, and prevents alveoli collapse during expiration. In minutes, oxygenation levels improve.

International Brands of Beractant:

  • Surfacten
  • Survanta
  • Survanta-Vent

Beractant Brands in Pakistan:

Beractant [Inj 25 mg/ml]

Survanta Abbott Laboratories (Pakistan) Limited.