Curosurf Dosage/Direction for Use

Rescue treatment: The recommended dose is a single dose of 100-200 mg/kg (1.25-2.5 ml/kg) of body weight. It is possible to administer additional doses of 100 mg/kg, each one at about 12-hourly intervals, in infants still requiring assisted ventilation and supplementary oxygen (maximum total dose: 300-400 mg/kg). It is recommended to start treatment as soon as possible after diagnosing RDS.
Prophylaxis: A single dose of 100-200 mg/kg (1.25-2.5 ml/kg) should be administered as soon as possible (within 15 minutes) after birth. Further doses of 100mg/kg can be given 6-12 hours after the first dose, and then at 12 hours intervals in case of occurrence of RDS requiring mechanical ventilation (max. total dose: 300-400 mg/kg).
Method of administration: CUROSURF is available in ready-to-use vials that should be stored in a refrigerator at +2 to +8°C. The vial should be warmed to 37°C before use, and gently turned upside down, without shaking, in order to obtain a homogeneous suspension. The suspension should be withdrawn from the vial by using a sterile needle and syringe.
In order to draw the suspension, carefully follow the instructions as follows: 1) Locate the notch (FLIP UP) on the colored plastic cap.
2) Lift the notch and pull upwards.
3) Pull the plastic cap with the aluminium portion downwards.
4) Remove the whole ring by pulling off the aluminium wrapper.
5) Remove the rubber cap to extract content.
CUROSURF can be administrated either by: A) Disconnecting the infant from the ventilator: Disconnect the infant momentarily from the ventilator and administer 1.25-2.5 ml/kg (100-200 mg/kg) of the suspension, as a single bolus, directly into the lower trachea via the endotracheal tube. Perform approximately one minute of hand-bagging and then reconnect the infant to the ventilator at the same settings as before administration.
Further doses (1.25 ml/kg equivalent to 100 mg/kg) that may be required can be administered in the same manner.
B) Without disconnecting the infant from the ventilator: Administer 1.25 - 2.5 ml/kg (100-200 mg/kg) of the suspension, as a single bolus, directly into the lower trachea by passing a catheter through the suction port and into the endotracheal tube. Further doses (1.25 ml/kg equivalent to 100 mg/kg) that may be required can be administered in the same manner.
C) Intubation Surfactant Extubation (INSURE): Intubate the neonate for the sole purpose of administering the surfactant. Doses are the same indicated at points A) and B).
In this case the neonate is ventilated manually and after administration of the surfactant and extubation, nasal CPAP (Continuous Positive Airway Pressure) may be performed.
D) Less Invasive Surfactant Administration with a thin catheter (LISA): Alternatively, in spontaneously breathing preterm new-borns CUROSURF can also be administered through the Less Invasive Surfactant Administration (LISA) technique using a thin catheter. Doses are the same indicated at points A), B) and C).
A small diameter catheter is placed into the trachea of infants on CPAP, ensuring continuous spontaneous breathing, with direct visualisation of the vocal cords by laryngoscopy. CUROSURF is instilled by a single bolus over 0.5-3 minutes. After CUROSURF instillation, the catheter is immediately removed. CPAP treatment should be continued during the whole procedure.
It is recommended to frequently control blood gases whatever administration is used, as, after administration, an immediate increase of PaO₂ or oxygen saturation is generally observed. It is however advisable to continuously monitor transcutaneous PO₂ or oxygen saturation to avoid hyperoxia.