Lucinactant (Surfaxin) is a synthetic surfactant that replaces the endogenous human surfactant. It is indicated for the prophylactic treatment of premature infants who are at risk of developing respiratory distress syndrome.

Lucinactant Uses:

• Respiratory distress syndrome:

  • It is indicated for the prevention of respiratory distress syndrome (RDS) in premature infants who are at a high risk of developing respiratory distress syndrome (RDS).

Other commonly used surfactants include:

• Poractant alfa
• Calfactant
• Beractant
• BLES (Bovine lipid extract surfactant)

Use in Adults: 

Not indicated.

Lucinactant (Surfaxin) Dose in Children:

Lucinactant (Surfaxin) Dose for the prophylaxis of infants with Respiratory distress syndrome:

• Premature Infants:

  • Endotracheal:

    • 5.8 mL/kg of birth weight.
    • The dose may be repeated thrice for up to a total of four doses administered subsequently at intervals of 6 hours within the first 48 hours of life.
    • Guidelines suggest that frequent dosing (at intervals of less than 12 hours) is not necessary unless the surfactant is inactivated by blood, meconium, or infection.

Note: For newborns who do not require mechanical ventilation for severe RDS, current guidelines recommend using CPAP immediately after birth with subsequent selective surfactant administration (AAP [Polin 2014]).

Dose in Kidney Disease:

There are no dosage adjustments provided in the manufacturer's labeling.

Dose in Liver disease:

There are no dosage adjustments provided in the manufacturer's labeling.

The following events were observed during the dosing procedure.

Common Side Effects of Lucinactant (Surfaxin):

• Gastrointestinal:

  • Endotracheal tube reflux

• Hematologic & oncologic:

  • Oxygen desaturation

• Miscellaneous:

  • Obstruction of the endotracheal tube

Less Common Side Effects of Lucinactant (Surfaxin):

• Cardiovascular:

  • Bradycardia

Contraindications to Lucinactant (Surfaxin):

FDA-approved labeling does not contain any contraindications.

Warnings and precautions

• Transient adverse effects:

  • It is possible to experience transient episodes of bradycardia or hypoxemia, endotracheal obstruction, reflux of the ETT, and other symptoms such as bradycardia, hypoxemia or bradycardia.
  • Before administering the dose, stabilize the patient (interrupt treatment until you give the next dose). Once the infant is stable, you can reintroduce the treatment.

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Monitoring parameters:

• Monitor heart rate and transcutaneous O2 saturation
• Ventilator settings
• Frequent sampling of arterial blood gases is necessary to prevent post-dosing hyperoxia and hypocarbia.

How to administer Lucinactant (Surfaxin)?

For endotracheal administration only.

• Warm the suspension before administering it. Shake the vial vigorously.
• After shaking, inspect it and ensure that the suspension is uniform, opaque white to off-white, and free flowing.
• The required amount of the drug should be drawn into a single, appropriately sized syringe depending on the volume of the solution to be used (using a 16 or 18-gauge needle).
• Before administration of the drug, airway suctioning may be required and the neonate should be stabilized before administering the drug.
• The drug is then administered into the endotracheal tube via a 5-french end-hole catheter that is inserted in to the endotracheal tube.
• The drug is administered in four aliquots of 1.45 ml/kg each.
• The drug is administered while alternating the posture between right and left lateral decubitus.
• Each aliquot of the drug is administered as a bolus followed by positive pressure ventilation.
• The neonate should be stabilized between each aliquot administration.
• Heart rate should be monitored and kept above 120/minute and oxygen saturation should be kept above 90% before administering each aliquot.
• After the full dose (four aliquots) are administered, suctioning should be withheld for one hour unless signs of significant airway obstruction are noted.
• Keep the neonates' bed elevated at ≥10° for at least 1 to 2 hours.

Mechanism of action of Lucinactant (Surfaxin):

• Lucinactant (Surfaxin), is used to replace the endogenous lungs surfactant in neonates deficient or lacking in it.
• This reduces the risk of respiratory distress syndrome.
• Surfactant is required in the lungs to prevent alveoli from collapsing during expiration.
• It reduces the tension between the air and alveolar surfaces.
• It is a synthetic surfactant that contains phospholipids (KL4 Peptide) that closely resembles the human surfactant proteins (SP-B) in order to mimic its action.

International Brand Names of Lucinactant:

Surfaxin

Lucinactant Brand Names in Pakistan:

No Brands Available in Pakistan.