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LUNG SURFACTANTS AND ANTENATAL CORTICOSTEROIDS | ||
DRUG NAME | beractant (Survanta), calfactant (Infasurf), poractant alfa (Curosurf) | betamethasone (Celestone Soluspan), dexamethasone (Decadron) |
CLASS | Exogenous lung surfactants | Corticosteroids |
MECHANISM OF ACTION | Form a film coating the inner alveolar walls to reduce the surface tension and prevent the alveoli from collapsing | Promote fetal lung maturation and stimulate the production of endogenous lung surfactant by type II pneumocytes |
INDICATIONS | Preterm newborns before 34 weeks of gestation | Expected preterm labor between 24 and 34 weeks of gestation |
ROUTE(S) OF ADMINISTRATION |
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SIDE EFFECTS |
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CONTRAINDICATIONS AND CAUTIONS |
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NURSING CONSIDERATIONS: LUNG SURFACTANTS AND ANTENATAL CORTICOSTEROIDS | ||
BERACTANT, CALFACTANT, PORACTANT ALFA | Preadministration
During administration
After administration
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BETAMETHASONE, DEXAMETHASONE |
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Lung surfactants are lipoproteins produced and secreted by type II pneumocytes lining the lung alveoli to keep them from collapsing when air is exhaled.
The production of surfactants typically begins at around week 26 of gestation, and reaches sufficient levels by week 35. So, preterm babies born before that don't produce enough lung surfactants.
As a consequence, their alveoli collapse, leading to neonatal respiratory distress syndrome. To prevent this, preterm babies are administered exogenous lung surfactants.
Commonly used exogenous lung surfactants include beractant, which is a bovine lung derivative; calfactant, which is a calf lung derivative; and poractant alfa, which is a porcine lung derivative.
Exogenous surfactants are usually administered directly into the newborn’s airways through an endotracheal, or ET tube, or via less invasive surfactant administration or LISA for short, such as nebulized surfactant preparations, laryngeal masks, and intratracheal instillation.
Once administered, lung surfactants form a film that coats the inner walls of the alveoli. This film decreases the surface tension, which helps maintain the alveolar shape by preventing the inner walls from sticking to each other and collapsing during expiration.
Now, before birth, corticosteroids like betamethasone and dexamethasone can be administered to promote fetal lung maturation. This is also known as antenatal corticosteroid therapy, and it is usually administered intramuscularly to pregnant clients at 24 to 33 weeks and 6 days of gestation who are expected to go into preterm labor.
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