Some of the views expressed in the following notes on newly approved products should be regarded as preliminary, as there may have been limited published data at the time of publication, and little experience in Australia of their safety or efficacy. However, the Editorial Executive Committee believes that comments made in good faith at an early stage may still be of value. Before new drugs are prescribed, the Committee believes it is important that more detailed information is obtained from the manufacturer's approved product information, a drug information centre or some other appropriate source.
Survanta (Abbott Australasia)
vials containing 200 mg/8 mL suspended in 0.9% sodium chloride solution
Indication: respiratory distress syndrome
The lack of surfactant in the lungs of premature neonates can cause respiratory distress syndrome (RDS). An artificial surfactant is available for treatment (see 'New drugs' Aust Prescr 1992;15:58), but this new product is also approved for preventive use.
Beractant is produced by adding substances such as colfosceril palmitate to an extract of bovine lungs to mimic natural surfactant. By lowering the alveolar surface tension, beractant can prevent the alveoli from collapsing during respiration.
The modified extract is given into the trachea and there are detailed instructions how to do this. While many babies who develop RDS will be intubated, elective intubation is needed when beractant is used to prevent RDS. If prevention is required, the first dose must be given within 15 minutes of birth.
In the treatment of RDS, beractant is as effective as colfosceril palmitate in reducing death and bronchopulmonary dysplasia.1 The outcome of prevention or treatment may be influenced by birth weight and the use of steroids before delivery.
Many of the adverse effects of beractant are related to the dosing procedure. Disconnecting the ventilator to give beractant can result in bradycardia or a fall in oxygen saturation. In some studies, the rate of intracranial haemorrhage has been higher in patients treated with beractant than in the control groups. This effect is not seen when the results of all controlled trials are pooled.
- Horbar JD, Wright LL, Soll RF, Wright EC, Fanaroff AA, Korones SB, et al. A multi center randomized trial comparing two surfactants for the treatment of neonatal respiratory distress syndrome. J Pediatr 1993;123:757-66.