Poractant Alfa (Porcine Surfactant)

How it works

It replaces deficient endogenous surfactant, the phospholipid-protein complex that lowers alveolar surface tension, thereby preventing alveolar collapse at end-expiration and improving lung compliance and oxygenation.

Prescribing in practice

• It must be administered via the endotracheal route by clinicians skilled in neonatal intubation and ventilation, with monitoring for transient airway obstruction, desaturation and bradycardia during instillation.
• Rapid improvement in lung compliance after dosing necessitates prompt adjustment of ventilator settings and oxygen to avoid hyperoxia and air leak.
• Administer according to the SPC and local neonatal protocols; repeat doses may be given if respiratory distress persists or recurs.

Monitoring

Monitor oxygen saturation, heart rate and ventilation continuously during and after administration, adjusting respiratory support to the rapidly changing lung mechanics.

Counselling the patient

• Explain to parents that this medicine replaces a natural substance the premature baby's lungs have not yet made enough of, helping the lungs stay open.
• It is given directly into the breathing tube by the neonatal team.
• The baby's ventilator settings will be adjusted quickly as breathing improves.

Evidence & guidelines

Surfactant replacement is a cornerstone of neonatal RDS care, with trials and meta-analyses showing reduced mortality and air leak, and animal-derived surfactants such as poractant alfa generally favoured over synthetic alternatives.