Neonatal Drug Therapy Manual


Disclaimer: Official controlled document is the CHEO and Ottawa Hospital online copy. It is the responsibility of user to ensure that any paper copy version is the same as the online version before use.

Alternate Name(s): 
Bovine Lipid Extract Surfactant
Lung Surfactant
Original Date: 
April 2002
Revised Date: 
October 2013
  • Respiratory Distress Syndrome (prophylaxis and treatment)
  • Intratracheal instillation
  • BLES should be warmed to at least room temperature, but not higher than 37°C before being administered
  • See policies and procedures on BLES     
  • Each dose should be administered in -2 aliquots
  • 5 mL/kg/dose
  • As many as 3 subsequent doses can be given within the first 5 days of life (max. of 4 doses)
  • 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 labelled expiry date before discarding.
  • 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.



- BLES (bovine lipid extract surfactant) Product Monograph.  BLES Biochemicals Inc.  London, Ontario,  Canada August 2010.

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