Lucinactant (Intratracheal)

Lucinactant is used in the prevention of respiratory distress syndrome in premature infants.

Overview

Lucinactant is used to prevent the development of respiratory distress syndrome. This condition occurs in premature infants. It occurs because their lungs have not fully formed at this stage in gestational developments and are therefore not capable of producing enough surfactant. Surfactant is produced naturally in the lungs to allow normal breathing to occur. Lucinactant is administered intractracheally to the infant and is only ever given under the direct supervision of a specifically trained doctor with experience in the care and resection of neonatal infants.

Lucinactant is given in the form of surfaxin and is provided as a suspension for administration.

Condition treated

  • Respiratory distress syndrome, prevention of

Type Of Medicine

  • Surfactant

Side Effects

As well as the desired effects of using Lucinactant for the treatment of premature infants, other unwanted side effects may occur. When some of these side effects occur immediate medical attention may be required.

This medication will only be administered in a hospital under the direct supervision of a doctor. If you notice any of the following side effects after treatment has been given, however, then you should inform the supervising doctor immediately:

Occurring more commonly:

  • Wheezing
  • Troubled breathing
  • Sneezing
  • Slow heartbeat
  • Shortness of breath
  • Rapid, shallow breathing
  • Pale skin
  • Fever or chills
  • Fast heartbeat
  • Coughing up blood
  • Cough
  • Bluish lips or skin

Frequency of incidence not known:

  • Patient unresponsive
  • No oxygen to lungs
  • Heart may stop
  • Blue or white in color

Other side effects can also occur that are less serious and will usually abate over time. These side effects will not normally need to be treated unless they are ongoing. The healthcare professional caring for your infant may also be able to help in alleviating the following side effects when they do occur:

Occurring more commonly:

  • Yellow eyes or skin
  • Vomiting of blood
  • Unusual bleeding or bruising
  • Swelling of the face, ankles, or hands
  • Sweating
  • Restlessness
  • Rash
  • Rapid, deep breathing
  • Loss of appetite
  • Fruit-like breath odor
  • Decreased urine output
  • Dark urine
  • Convulsions
  • Coma
  • Clay-colored stools

Other side effects from the use of this medication can also occur that have not been listed herein. If you notice any other side effects occurring in your infant then you should inform your doctor and seek advice.

Dosage

This medication can only be given by a trained medical professional in a hospital. This medication is administered directly into the lungs of your child though a breathing tube that is usually inserted through the nose.

The dose of Lucinactant given is calculated based on the birth weight of the premature infant. The dose given is usually calculated as 5.8ml/kg of weight at birth.

A maximum of four doses of Lucinactant can be given to the child in the first 48 hours of life and the frequency of dosing should never exceed more than once every six hours.

Before use the medication should be warmed in the vial for 15 minutes. This should be done in a preheated block heater that is set to 44 °C.

Following warming the vial should be shaken vigorously to achieve a uniform suspension that flows freely. The substance should then be drawn into a syringe for treatment by which time the medication will have dropped in temperature to approximately 37 °C making it suitable for administration to the premature infant.

If the medication is not used immediately after warming then it can be stored in the dark for up to 2 hours but cannot be returned to a refrigerator. If it is not used within 2 hours then the medication must be discarded.

Each dose of Lucinactant should be administered as four separate aliquots. The ventilator settings may be adjusted by the doctor during administration for optimum delivery of the medication. Ventilation should be continued until the infant is stable with a heartrate of greater than 120bpm and oxygen saturation of a minimum of 90%.

Interactions

This medication should not be used in conjunction with any other medications or treatments without the express direction of the prescribing doctor. The doctor may make changes to the dose of this medication that is given depending on the other medications that are being given to your premature infant to prevent medication interactions from occurring.

Your child will be given a controlled diet while receiving this treatment. This diet will be free from any substances that may cause an interaction to occur.

Other medical problems from which the child is suffering can also affect the use of this treatment. The doctor may change the use of this treatment in the case that any of the following medical conditions are present

This medication should not be used in premature infants with the following condition:

  • Acute respiratory distress syndrome

The following conditions may be worsened by the use of Lucinactant:

  • Airway blockage
  • Bradycardia

Other medical problems not listed can also affect the use of this medication. Your child will be regularly assessed to determine the best treatment for development and recovery.

Warnings

Before this medication is used it is important to understand the risks of use in relation to the benefits of use. You will make this decision with the prescribing doctor having considered all of the following factors:

Allergies: Allergies can be prevalent in premature babies and certain allergies may prohibit the use of this medication. Your premature infant will sometimes be skin tested for allergies before receiving treatments such as Lucinactant to determine if any allergies are present.

Pediatric: This medication is intended for pediatric use in the treatment of premature infants.

Geriatric: This medication is not intended for use in elderly patients and no tests have been performed.

This medication will only be given where the condition of the premature infant can be closely monitored. The doctor will need to assess that the medication is working properly and check for unwanted side effects that may be occurring. The doctor will make regular checks to see that your child should continue to keep taking the medication.

The administration of Lucinactant can rapidly and dramatically change the ability of the lungs to carry out oxygenation. The medication should only be administered by healthcare professionals with training in resuscitation, incubation, stabilization and ventilator management with a particular focus on the care of premature infants within a hospital setting that is set up for the treatment of seriously ill neonates. This treatment should not be carried out if these conditions are not met.

The infant receiving this treatment will be likely to experience rapid changes in the ability to process oxygen and their ventilator support must be constantly checked and adjusted with the needs of the infant in this early stage of life.

This medication should not be used in adults in need of treatment for ARDS. In clinical trials the use of this medication for such a purpose was shown to increase the incidence of death and of other very serious complications.

There is a risk of sepsis occurring from the use of this medication in premature infants. This can be life-threatening but the benefits of use greatly outweigh the risks as treatment can prevent immediate death.

Storage

Lucinactant should be kept in the refrigerator at a controlled temperature of 2-8 °C.

Do not allow the medication to freeze or warm. Discard any vials that fall outside of this temperature range.

Vials are for single use only and should not be stored after opening.

Summary

Lucinactant is a treatment used to replace Surfactant in premature babies. Surfactant is naturally produced by the lungs to allow people to breathe, but in premature babies the lungs may not be developed enough to produce enough of this substance to allow for effective oxygenation. Lucinactant is applied to replace the missing Surfactant in the lungs of the infant and is administered immediately after birth.

The administration of Lucinactant can prevent the occurrence of respiratory distress syndrome in premature babies. In the first 48 hours of life a premature infant may be treated with up to four doses of this medication.

The use of Lucinactant carries risks of the occurrence of sepsis and other unwanted side effects but the benefits of use and the preservation of life outweigh these risks.

Lucinactant can only be administered by a doctor who is trained and experienced in the resuscitation and incubation of premature infants. It is also only allowed in a hospital environment that is properly set up for such a treatment to be performed.

The parents of the premature infant will not be able to be present during this treatment as it will take place in a neonatal intensive care unit where access is prohibited.

This medication may be administered along with a wide range of other treatments intended to preserve the life of the premature infant.