Resp: oxygen desaturation (as a result of administration process)
Interactions⬆⬇
Drug-drug:
None known.
Route/Dosage⬆⬇
Intratracheal (Infants , Premature): 100 mg phospholipids/kg birth weight(4 mL/kg birth weight); 4 doses may be given in first 48 hr of life, no closer than q 6 hr apart.
Availability⬆⬇
Intratracheal suspension: 25 mg phospholipid/mL—4–mL and 8-mL vials
Assessment⬆⬇
Monitor ECG, heart rate, color, chest expansion, facial expression, transcutaneous oxygen saturation, and endotracheal tube patency continuously during dosing. Continuous bedside monitoring should continue for at least 30 min after dosing.
If bradycardia and decreased oxygen saturation occur during dosing, stop the dosing procedure and initiate measures to alleviate the condition. Then resume dosing.
Lab Test Considerations:
Monitor ABGs frequently to prevent hyperoxia or hypocarbia.
Implementation⬆⬇
Only trained medical personnel with experience in airway and clinical management of unstable neonates should perform beractant instillation.
Inhaln: Does not require reconstitution. Inspect for discoloration before administration. Color should be off-white to light brown. If settling occurs, swirl gently; do not shake. Beractant must be refrigerated. Warm before administration by allowing to stand at room temperature for 20 min, or warm in the hand for at least 8 min. Do not use artificial warming methods such as a microwave oven. Unopened vials that have been warmed may be returned to the refrigerator within 24 hrs of warming. Do not warm and re-refrigerate more than once. Discard unused doses.
Administer intratracheally through a 5 French end-hole catheter inserted into the infant’s endotracheal tube with the tip protruding just beyond the end of the endotracheal tube above the infant’s carina. Shorten the length of the catheter before insertion to avoid instillation into main-stem bronchus.
Determine dose and withdraw entire contents of vial into a plastic syringe with a large-gauge (at least 20-gauge) needle. Do not filter or shake. Attach catheter to end of syringe. Fill catheter with beractant and discard excess through catheter so that only the total dose remains in the syringe.
Suction the infant endotracheally before instillation of beractant. Check position of endotracheal tube before instillation. Do not suction for 1 hr after instillation unless clinically necessary.
Rate: To ensure homogeneous distribution, each dose should be divided into four 1/4 doses. Each 1/4 dose should be administered gently over 2–3 sec with the infant in different positions. Sequence of positions is head and body inclined slightly down, head turned to the right; head and body inclined slightly down, head turned to the left; head and body inclined slightly up, head turned to the right; head and body inclined slightly up, head turned to the left. Ventilate the infant for at least 30 sec or until stable between each 1/4 dose. After instillation of the last 1/4 dose, remove the catheter without flushing it.
Prevention Strategy: Administer within 15 min of birth, if possible. Between each 1/4 dose, manually ventilate with a hand bag with sufficient oxygen to prevent cyanosis, at a rate of 60 breaths/min, and sufficient positive pressure for adequate air exchange and chest wall excursion.
Rescue Strategy: Administer as soon as possible after infant is placed on the ventilator for management of RDS (preferably by 8 hr of age). Immediately before instillation of first 1/4 dose and between each 1/4 dose, ventilate with ventilator settings at 60/min, inspiratory time 0.5 sec, and FIO2.
Repeat Doses: Can be given no sooner than 6 hr after preceding dose. Obtain radiologic confirmation of RDS before repeat dose in those who received drug for prevention. FIO2 may be increased by 0.2 or amount sufficient to prevent cyanosis. Ventilator rate may be set at 30/min with an inspiratory time of <1 sec. If pretreatment rate was ≥30/min, it may be unchanged during repeat dose. Do not use manual hand bag ventilation during repeat doses. Repeat doses should be based on birth weight.
