Government hospitals across Tamil Nadu are facing a shortage of surfactant medicines, a critical and life-saving medicine for pre-term babies.

The shortage has been persisting for the past few months, and several Special Newborn Care Units (SNCUs) at government hospitals have been flagging it up for the Health Department.

Doctors said surfactant medicines are essential to inflate the lungs of pre-term babies in need of the therapy. They utilised external bovine or porcine surfactants (intratracheal) in pre-term babies. These surfactants were part of the speciality drug rate contract purchases of the Tamil Nadu Medical Services Corporation (TNMSC).

Inquiries with a number of hospitals and doctors revealed that a number of centres were facing short supply of surfactants in the past few months. Official sources confirmed that government hospitals, among them medical college hospitals in Theni, Dharmapuri, Tiruppur, Cuddalore, Tiruvannamalai, Vellore and Karur districts and in Chennai, reported surfactant vial shortage, while some hospitals said they had uninterrupted supply.

A doctor, speaking on condition of anonymity, said the shortage prevailed in the past three to four months owing to a number of factors. “First, we got no allotment. Secondly, some centres miscalculated their requirement, which is based on the average number of pre-term babies delivered, and thirdly, there was higher utilisation. This is a life-saving medicine essential to inflate the lungs of pre-term babies who are otherwise solid,” he said.

A doctor at another hospital said continuous supply was not assured, and shortage occurred frequently.  “Currently, we are borrowing from other sub-centres which are referring babies to us. It is very difficult for us to manage newborn units without surfactants. Sometimes, we purchase them privately using SNCU funds to save the babies,” another doctor said.

A senior paediatrician said that after 34 weeks of gestation, the foetal lungs are generally mature enough to support exchange of oxygen and carbon dioxide after birth. “However, in very pre-term babies, the alveoli, which are the tiny air sacs in the lungs, may not be sufficiently mature to function effectively on their own. Surfactant, a substance produced in the lungs, helps keep the alveoli open. But in babies born very prematurely, not enough surfactant may be produced, making it difficult for them to maintain adequate oxygen levels. Depending on the baby’s condition, doctors may use respiratory support such as CPAP or a mechanical ventilator. Surfactant is delivered directly into the lungs through the endotracheal tube to prevent hyaline membrane disease.”

Lung maturity in a newborn is critical as decreased oxygen could cause hypoxia and conditions such as retinopathy of prematurity and hypoxic-ischemic encephalopathy, he said.

A Health Department source denied that there was any shortage. “There was no procurement delay. Some centres may have miscalculated their requirement, resulting in shortage, or may have utilised more vials. In such circumstances, they have obtained the required supply from neighbouring facilities. A six-month purchase order, worth nearly ₹9 crore, has been issued. Additionally, operational costs are provided for paediatricians to make local purchases whenever required,” he said.

Another official said the TNMSC has issued purchase orders and it will be supplied within two days. Officials said Cuddalore faced shortage and arrangements were made to send supplies from Coimbatore. The situation was being closely monitored, they said.