Poractant alfa is highly
recommended in the European
Consensus Guidelines

1. If a preterm baby <30 weeks of gestation requires intubation for stabilisation, they should be given surfactant (A2).

2. Babies with RDS needing treatment should be given an animal-derived surfactant preparation (A1).

3. LISA is the preferred method of surfactant administration for spontaneously breathing babies on CPAP (A1).

4. Laryngeal mask surfactant may be used for more mature infants >1.0 kg (B2).

5. An initial dose of 200 mg/kg of poractant alfa is better than 100 mg/kg of poractant alfa or 100 mg/kg beractant for rescue therapy (A1).

6. Rescue surfactant should be given early in the course of the disease (A1). Suggested protocol would be to treat worsening babies with RDS when FiO₂ > 0.30 on CPAP pressure ≥6 cm H₂O or if lung ultrasound suggests surfactant need (B2).

7. A second and occasionally a third dose of surfactant should be given if there is ongoing evidence of RDS such as persistent high oxygen requirement and other problems have been excluded (A1).

Representations of quality of evidence and strength of recommendations