Poractant alfa is highly
recommended in the European
Consensus Guidelines

The 2022 European consensus guidelines on the management of respiratory distress syndrome (RDS) recommend an initial dose of poractant alfa 200 mg/kg based on the strongest evidence and recommendation level1.


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

Quality of evidence

High quality


Moderate quality


Low quality


Very low quality


Strength of recommendation

Strong recommendation for using intervention


Weak recommendation for using intervention


Premature baby girl in incubator

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