Beractant (survanta ) is a modified bovine pulmonary surfactant that reduces the surface tension between the alveolar surfaces and air.

It is used for the treatment and prevention of Respiratory distress syndrome in premature neonates with a birth weight of fewer than 1,250 gms or with evidence of surfactant deficiency. 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 Childrens

Dose in the treatment of Respiratory distress:

• Prophylactic therapy:
  • 4 mL/kg (100 mg phospholipids/kg) administered via an endotracheal tube as soon as possible after birth (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 a respiratory distress syndrome but do not require mechanical ventilation should be advised 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

Contraindication 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

Monitor:

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

How to administer Beractant?

• Before administering the drug, warm the drug by allowing it to stand at room temperature for twenty minutes or warming it in hands for eight minutes or more.
• Gently swirl the drug and make sure that complete mixing of the suspension has occurred.
• Do not shake it.
• Perform endotracheal suctioning before administering the drug.

Endotracheal administration: 

• Administration through an endotracheal tube using a 5-French end-hole catheter:
  • Before administering the drug, make sure the infant is stable.
  • Insert a 5 French end-hole catheter into the endotracheal tube.
  • Divide the dose into four portions and administer in four 1 mL/kg aliquots over 2 - 3 minutes followed by 30 minutes of manual ventilation or until the infant 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: