Colfosceril palmitate
(Dipalmitoylphosphatidylcholine, DPPC)
Colfosceril palmitate (Exosurf Neonatal)
Dipalmitoylphosphatidylcholine (Exosurf Neonatal)
DPPC (Exosurf Neonatal)
Colfosceril palmitate
(kohl- FOSS-sir-ill) Exosurf Neonatal (Rx)

Classification: Lung surfactant

Action/Kinetics: Contains dipalmitoylphosphatidylcholine (DPPC), which reduces surface tension in the lungs, as well as cetyl alcohol, which acts as a spreading agent for DPPC on the air-fluid surface. Also contains tyloxapol, which is a nonionic surfactant that assists in dispersion of DPPC and cetyl alcohol, and NaCl to adjust osmolality. The drug can rapidly affect oxygenation and lung compliance. DPPC is reabsorbed from the alveoli into lung tissue where it is broken down and reutilized for further phospholipid synthesis and secretion.

Uses: Prophylaxis of respiratory distress syndrome in infants with birth weights of less than 1,350 g and in infants with birth weights greater than 1,350 g who manifest pulmonary immaturity. Treatment of infants who have developed respiratory distress syndrome. Such infants should be on mechanical ventilation and should have been diagnosed as having respiratory distress syndrome.

Special Concerns: Use of colfosceril should be undertaken only by medical personnel trained and experienced in airway and clinical management of unstable premature infants. Although colfosceril is effective in reducing mortality due to premature birth, infants may still develop severe complications resulting in either death or survival but with permanent handicaps. Benefits versus risks should be carefully assessed before using colfosceril in infants weighing 500-700 g.

Side Effects: Respiratory: Pulmonary hemorrhage, pulmonary air leak (pneumothorax, pneumomediastinum, pneumopericardium, pulmonary interstitial emphysema), mucous plugs in the ET tube, apnea congenital pneumonia, nosocomial pneumonia. CV: Intraventricular hemorrhage patent ductus arteriosus, hypotension, bradycardia, tachycardia, exchange transfusion, persistent fetal circulation. Changes in blood gases: Fall or rise in oxygen saturation, fall or rise in transcutaneous pO ₂, fall or rise in transcutaneous pCO ₂. Miscellaneous: Necrotizing enterocolitis major anomalies, hyperbilirubinemia, gagging, thrombocytopenia, seizures.

How Supplied: Kit for Intratracheal Use

Dosage
?Intratracheal Prophylaxis.
5 mL/kg (as two 2.5-mL/kg half-doses) as soon as possible after birth. A second and third dose should be given 12 and 24 hr later to infants who are still on mechanical ventilation.
Rescue treatment.
5 mL/kg (as two 2.5-mL/kg half-doses) as soon as possible after the diagnosis of respiratory distress syndrome is confirmed. A second 5-mL/kg dose is given after 12 hr to infants who are still on mechanical ventilation. The safety and effectiveness of additional doses are not known.