Surfactant

Treatment

• 

  Representative Product

  GLOBAL ANNUAL DEATHS ASSOCIATED WITH RESPIRATORY DISTRESS

  PERCENT (%)

  NUMBER

  Maternal

  N/A

  N/A

  Neonatal

  20-25%

  765,000

  Stillbirth

  N/A

  N/A

  Condition
  Respiratory distress syndrome (RDS) is a condition among premature infants characterized by insufficient pulmonary surfactant and structural immaturity of the lungs. Surfactant decreases the surface tension of the water in the alveoli which allows the lungs to expand easier and more evenly. Without it, the alveoli become damaged and oxygenation is diminished. RDS is a leading cause of death among preterm infants.
  
  Mechanism of Action

  Surfactant is produced in the lungs to enable them to expand normally. It reduces the surface tension of the alveoli to prevent collapse. A preterm infant is often born with less than 10% the surfactant of a term neonate which makes breathing difficult, diminishes oxygenation, and can lead to further lung damage.

   

  Surfactant can be administered to make up for the neonate's lack of surfactant at birth. These materials are often synthetic, animal derived compounds of lipids and proteins to mimic human surfactant. Administration of surfactant into the lungs is costly and requires skill and often artificial ventilation.

   

  Current Use in High-Resource Settings
  Surfactant is administered either as a prophylaxis or as a rescue measure in response to RDS. It is generally administered by specialists in neonatal intensive care units or equivalent hospital departments. Current surfactants are administered as an injection by an endotracheal tube. This bolus then spreads to the distal airways as the lungs move. Most infants are mechanically ventilated after each surfactant dose, and extubated only when stable on minimal ventilation. Surfactant can be re-administered as necessary, every 6-12 hours.
  
  Application in Low-Resource Settings
  The high cost of both surfactant and its accompanying technologies mean that surfactants are used almost exclusively in well-equipped neonatal intensive care units. Recent data suggests that in very preterm infants (24-27 weeks gestation) CPAP may reduce the need for surfactant.
   

  Related Technologies in Development

  Seattle Children's Surfactant, Surfactant Replacement from the University of Florida

  REPRESENTATIVE DEVICES

  MAKE

  MODEL

  PRICE*

  TECH

  STATUS

  NOTES

  GSK

  Infasurf

  $1,000

  Synthetic

  Marketed

  First synthetic.

  bLES

  bLES

  $600

  Animal

  Marketed

  Derived from calf lung

  Abbott

  Survanta

  $450

  Animal

  Marketed

  Market leader; from bovine lung

  Chiesi

  Curosurf

  $400

  Animal

  Marketed

  Derived from porcine lung

  *Prices are approximated. Actual pricing can, and will vary by marketplace and market conditions.

• CHARACTERISTICS OF REPRESENTATIVE PRODUCT

  TECHNOLOGY CHARACTERISTICS

  OPERATIONAL PARAMETERS

  POTENTIAL OPPORTUNITIES FOR IMPROVEMENT

  SKILLS

  REQUIRED

  Intended end user

  Training required

  Time required per use

  Physician, NICU nurse

  Hours

  Minutes

  While administration of surfactant itself may not be complex, the accompanying interventions (intubation, ventilation, etc.) require substantial skill.

  ENVIRONMENT/ INFRASTRUCTURE

  Power required

  Waste collection

  Complementary technologies required

  Temperature and storage

  Maintenance

  None

  None

  Endotracheal tube, syringe, catheter

  2-8°C until use, when it should be warmed to room temperature

  None

  Surfactant can only be used in well-equipped NICU.

  COST

  Device Cost (Approx)

  Cost/course (Approx)

  $400-$500

  $400-$500+consumables

  Cost is a significant barrier to the adoption of surfactants, although there is some promise in low cost synthetic surfactants.

  OTHER

  Portability

  Regulatory

  Efficacy

  Not suitable for use outside hospitals

  As high as 30% reduction in mortality among preterm infants in hospital settings

  Additional devices often used: mechanical ventilation, vital signs monitoring, pulse oximetry, oxygen, CPAP