Lung surfactants and antenatal corticosteroids: Nursing pharmacology

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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
  • ET tube
  • LISA technique
  • IM
SIDE EFFECTS
  • Transient bradycardia and oxygen saturation
  • Fetal: reduced fetal movements and fetal heart rate variability
  • Maternal: infections and transient rise in serum glucose, pulmonary edema (rare)
CONTRAINDICATIONS AND CAUTIONS
  • Pulmonary hemorrhage
  • Congenital diaphragmatic hernia
  • Respiratory distress not caused by lung immaturity
  • Situations where immediate delivery is needed
    • e.g., cord prolapse, placental abruption, or chorioamnionitis
NURSING CONSIDERATIONS:
LUNG SURFACTANTS AND ANTENATAL CORTICOSTEROIDS
BERACTANT, CALFACTANT, PORACTANT ALFA
Preadministration
  • Teach parent(s) / guardian(s) about medication’s purpose and potential side effects
  • Document accurate weight; ensure correct correct dose is calculated
  • Ensure the ET tube or catheter is positioned appropriately; suction prior to administration
  • Bring to room temperature 20 minutes before administration; gently swirl vial to mix suspension before dosing

During administration
  • Monitoring: heart rate, oxygen saturation, skin color
  • Assist with positioning

After administration
  • Continued monitoring and assessment
  • Avoid suctioning for 1–2 hours following administration
  • Adjust ventilator settings as needed
BETAMETHASONE, DEXAMETHASONE
  • Teach client medication’s purpose and potential side effects, required monitoring
  • Confirm gestational age, results of prenatal gestational diabetes screening
  • Administer IM in large muscle mass; do not massage
  • Monitoring: vital signs, lung sounds, glucose level, labor status

Transcript

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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.

Sources

  1. "Focus on Nursing Pharmacology" LWW (2019)
  2. "Pharmacology" Elsevier Health Sciences (2014)
  3. "Mosby's 2021 Nursing Drug Reference" Mosby (2020)
  4. "Saunders Comprehensive Review for the NCLEX-RN Examination" Saunders (2016)
  5. "Surfactant administration in neonates: A review of delivery methods" NCBI (2014)
  6. "SURVANTA® (beractant, intratracheal suspension)" Abbvie (2021)
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