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Respiratory distress treatment: Premature infants: Prophylactic treatment: Endotracheal: Administer 4 mL/kg (100 mg phospholipids/kg) as soon as possible; as many as 4 doses may be administered during the first 48 hours of life, no more frequently than 6 hours apart. The need for additional doses is determined by evidence of continuing respiratory distress; if the infant is still intubated and requiring at least 30% inspired oxygen to maintain a PaO 2 ≤80 torr. Rescue treatment: Endotracheal: Administer 4 mL/kg (100 mg phospholipids/kg) as soon as the diagnosis of RDS is made; may repeat if needed, no more frequently than every 6 hours to a maximum of 4 doses Dosing: Renal Impairment No dosage adjustment provided in manufacturer’s labeling. Dosing: Hepatic Impairment No dosage adjustment provided in manufacturer’s labeling. Dosage Forms: U.S. Excipient information presented when available (limited, particularly for generics); consult specific product labeling. Suspension, intratracheal [bovine derived, preservative free]: Survanta®: Phospholipids 25 mg/mL (4 mL, 8 mL) Generic Equivalent Available: U.S. No Administration

For endotracheal administration only Suction infant prior to administration. Inspect solution to verify complete mixing of the suspension (may swirl gently, but DO NOT SHAKE). Do not filter dose and avoid shaking. Administer endotracheally by instillation through a 5-French end-hole catheter inserted into the infant's endotracheal tube. Administer the dose in four 1 mL/kg aliquots. Each quarter-dose is instilled over 2-3 seconds followed by at least 30 seconds of manual ventilation or until stable; each quarter-dose is administered with the infant in a different position. Slightly downward inclination with head turned to the right, then repeat with head turned to the left; then slightly upward inclination with head turned to the right, then repeat with head turned to the left. Following administration of one full dose, withhold suctioning for 1 hour unless signs of significant airway obstruction. Use Prevention and treatment of respiratory distress syndrome (RDS) in premature infants Prophylactic therapy: Body weight <1250 g in infants at risk for developing, or with evidence of, surfactant deficiency (administer within 15 minutes of birth) Rescue therapy: Treatment of infants with RDS confirmed by x-ray and requiring mechanical ventilation (administer as soon as possible - within 8 hours of age) Medication Safety Issues Sound-alike/look-alike issues: Survanta® may be confused with Sufenta® Adverse Reactions Significant During the dosing procedure: >10%: Cardiovascular: Transient bradycardia 1% to 10%: Respiratory: Oxygen desaturation <1% (Limited to important or life-threatening): Apnea, endotracheal tube blockage, hypercarbia, hyper-/hypotension, post-treatment nosocomial sepsis probability increased, pulmonary air leaks, pulmonary interstitial emphysema, vasoconstriction Contraindications There are no contraindications listed within the FDA-approved labeling Warnings/Precautions

Concerns related to adverse effects: • Transient adverse effects: Transient episodes of bradycardia and decreased oxygen saturation occur. Discontinue dosing procedure and initiate measures to alleviate the condition; may reinstitute after the patient is stable.

Other warnings/precautions: • Administration: For endotracheal administration only. • Monitoring: Produces rapid improvements in lung oxygenation and compliance that may require frequent adjustments to oxygen delivery and ventilator settings. • Trained personnel: Rapidly affects oxygenation and lung compliance; restrict use to a highly-supervised clinical setting with immediate availability of clinicians experienced in intubation and ventilatory management of premature infants. Metabolism/Transport Effects None known. Drug Interactions (For additional information: Launch Lexi-Interact™ Drug Interactions Program ) There are no known significant interactions. Pricing: U.S. (Medi-Span®)

Suspension (Survanta Inhalation) 25 mg/mL 0.9% (4 mL): $459.60 Monitoring Parameters Continuous ECG and transcutaneous O 2 saturation should be monitored during administration; frequent arterial blood gases are necessary to prevent postdosing hyperoxia and hypocarbia International Brand Names Surfacten (JP); Survanta (AE, AR, AT, AU, BB, BE, BG, BH, BM, BR, BS, BZ, CH, CO, CR, CY, CZ, DE, DO, EC, EG, ES, FR, GB, GR, GT, GY, HK, HN, HU, ID, IE, IL, IQ, IR, JM, JO, KW, LB, LU, LY, MX, MY, NI, NL, NO, NZ, OM, PA, PE, PH, PK, PL, PR, QA, SA, SG, SR, SV, SY, TH, TT, TW, YE, ZA); Survanta-Vent (SE) Mechanism of Action Replaces deficient or ineffective endogenous lung surfactant in neonates with respiratory distress syndrome (RDS) or in neonates at risk of developing RDS. Surfactant prevents the alveoli from collapsing during expiration by lowering surface tension between air and alveolar surfaces. Pharmacodynamics/Kinetics Excretion: Clearance: Alveolar clearance is rapid Use of UpToDate is subject to the Subscription and License Agreement . Topic 9122 Version 34.0 © 2013 UpToDate, Inc. All rights reserved. | Subscription and License Agreement | Release: 21.3 - C21.34 Licensed to: Morehouse School of Medicine | Support Tag: [0603-41.78.124.10-D5AC4AD6BF-S473950.14]