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Drugs acting on the respiratory system
Adverse effects
Adverse effects that are associated with the use of lung
surfactants include patent ductus arteriosus, brady-
cardia, hypotension, intraventricular haemorrhage,
pneumothorax, pulmonary air leak, hyperbilirubi-
naemia and sepsis. These effects may be related to the
immaturity of the neonate, the invasive procedures used
or reactions to the lipoprotein.
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Lung surfactants are naturally occurring compounds
that reduce the surface tension in the alveoli, allowing
them to expand. They are injected directly into the
trachea of neonates who have RDS.
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Administration of lung surfactants requires proper
placement of the endotracheal tube, suctioning of the
neonate before administration (but not for 2 hours
after administration unless necessary) and careful
monitoring and support of the neonate to ensure lung
expansion and proper oxygenation.
KEY POINTS
Prototype summary: Beractant
Indications:
Prophylactic treatment of infants at high
risk for developing RDS; rescue treatment of infants
who have developed RDS.
Actions:
Natural bovine compound of lipoproteins
that reduce the surface tension and allow expansion
of the alveoli; replaces the surfactant that is missing
in infants with RDS.
Pharmacokinetics:
Route
Onset
Peak
Intratracheal
Immediate
Hours
T
1/2
:
Unknown; metabolised by surfactant pathways.
Adverse effects:
Patent ductus arteriosus,
intraventricular haemorrhage, hypotension,
bradycardia, pneumothorax, pulmonary air leak,
pulmonary haemorrhage, apnoea, sepsis, infection.
Care considerations for
neonates receiving lung surfactants
Assessment: History and examination
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Assess for
possible contraindications or cautions
:
screen for time of birth and exact weight
to
determine appropriate doses.
Because this drug
is used as an emergency treatment, there are no
contraindications to screen for.
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■
Perform a physical examination
to establish
baseline data for assessing the effectiveness of the
drug and the occurrence of any adverse effects
associated with drug therapy.
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■
Assess the skin temperature and colour
to evaluate
perfusion.
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Monitor respirations, adventitious sounds,
endotracheal tube placement and patency and chest
movements
to evaluate the effectiveness of the drug
and drug delivery.
■
■
Evaluate blood pressure, pulse and arterial pressure
to monitor the status of the neonate.
■
■
Evaluate blood gases and oxygen saturation
to
monitor drug effectiveness.
■
■
Assess temperature and full blood count
to
monitor for sepsis.
Implementation with rationale
■
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Monitor the neonate continuously during
administration and until stable
to provide life
support measures as needed.
■
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Ensure proper placement of the endotracheal tube
with bilateral chest movement and lung sounds
to
provide adequate delivery of the drug.
■
■
Have staff view the manufacturer’s teaching video
before regular use
to review the specific technical
aspects of administration.
■
■
Suction the infant immediately before
administration, but do not suction for 2 hours
after administration unless clinically necessary,
to allow the drug time to work.
■
■
Provide support and encouragement to parents,
explaining the use of the drug in the teaching
program,
to help them cope with the diagnosis and
treatment of their baby.
■
■
Continue other supportive measures related to the
immaturity of the neonate
because this is only
one aspect of medical care needed for premature
infants.
Evaluation
■
■
Monitor response to the drug (improved breathing,
alveolar expansion).
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Monitor for adverse effects (pneumothorax, patent
ductus arteriosus, bradycardia, sepsis).
■
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Evaluate the effectiveness of the teaching plan, and
support parents as appropriate.
■
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Monitor the effectiveness of other measures to
support breathing and stabilise the neonate.
■
■
Evaluate the effectiveness of other supportive
measures related to the immaturity of the
neonate.
