Alternate Name(s):
Bovine Lipid Extract Surfactant
Classification:
Lung Surfactant
Original Date:
April 2002
Revised Date:
February 2025
Indications:
- Respiratory Distress Syndrome (prophylaxis and treatment)
Administration:
- Intratracheal instillation ONLY. No reconstitution or filtering required
- BLES should be warmed to at least room temperature, but not higher than 37°C before being administered
- Inspect the vial for homogeneity. It is normal for warmed vials to have an even dispersion of fine but visible flecks of lipid. If contents appear darker in colour or do not disperse easily, do not use. The suspension should appear off white to yellow.
- BLES may also be administered as per the MIST protocol. See your institution-specific policy for administration via MIST
Dosage:
- 5 mL/kg birth weight (+ 0.5 ml Air or leftover surfactant for catheter dead space), divided in two aliquots
- Up to 3 repeat doses can be given at approximately 2 - 6 hours intervals within the first 5 days of life (MAX of 4 doses)
- The criteria for an additional dose are a positive response to the previous dose, and an increase in respiratory support as signaled by a gradual increase in FiO2. This increase must be at least 10% greater than the FiO2 required after the initial response to the previous dose of BLES.
- For extremely unstable infants (especially persistent pulmonary hypertension of the newborn), 2.5 mL/kg should be given initially. The remaining 2.5 mL/kg should be given immediately after if the first-half dose has been well tolerated
Side Effects:
- CVS: vasoconstriction, hypo or hypertension
- Respiratory: apnea, endotracheal tube blockage
- During the dosing procedure, transient episodes of bradycardia and decreased oxygen saturation have been reported. If these occur, the dosing procedure should be stopped and resumed after stabilization
Parameters to Monitor:
- HR
- Blood gas,
- Chest expansion, air entry, colour, oxygen saturation
Reconstitution and Stability:
- Store vials in cartons or in UV bags in freezer until ready for use. Unopened vials warmed to room temperature for less than 6 hours may be returned to its previous storage condition for a maximum of 2 times. Thawed vials may be kept in the refrigerator for up to 10 months within the labeled expiry date before discarding. Refrigerated vials should not be returned to the freezer.
- Discard opened vials. Single Use Only.
- If a precipitate is evident at room temperature, gently swirl the vial until homogenous; if unable to suspend to homogeneity, discard the vial.
Compatibility:
N/A
References:
- BLES (bovine lipid extract surfactant) Product Monograph. BLES Biochemicals Inc. Accessed Februrary 2025.