Tamil Nadu Government Hospitals Face Shortage of Life-Saving Surfactant for Pre-term Babies

Government hospitals across Tamil Nadu are facing a shortage of surfactant medicines, a critical life-saving drug for pre-term babies, according to doctors and official sources. The shortage has persisted for the past few months, with several Special Newborn Care Units (SNCUs) flagging the issue to the Health Department.

Surfactant is essential to inflate the lungs of pre-term babies who need the therapy. It is a substance produced in the lungs that helps keep the alveoli—the tiny air sacs—open. Babies born very prematurely may not produce enough surfactant, making it difficult for them to maintain adequate oxygen levels. Doctors use external bovine or porcine surfactants (intratracheal) in such cases. These surfactants are part of the speciality drug rate contract purchases of the Tamil Nadu Medical Services Corporation (TNMSC).

Inquiries with hospitals and doctors revealed that several centres have faced short supply in recent months. Official sources confirmed that government hospitals, including medical college hospitals in Theni, Dharmapuri, Tiruppur, Cuddalore, Tiruvannamalai, Vellore and Karur districts, as well as in Chennai, reported surfactant vial shortages. Some hospitals, however, said they had uninterrupted supply.

A doctor, speaking on condition of anonymity, said the shortage had prevailed for three to four months due to multiple 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.

Another doctor said continuous supply was not assured, and shortages 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,” the doctor added.

A senior paediatrician explained that after 34 weeks of gestation, foetal lungs are generally mature enough to support the exchange of oxygen and carbon dioxide after birth. “However, in very pre-term babies, the alveoli may not be sufficiently mature to function effectively on their own. Surfactant 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, the paediatrician said.

A Health Department source denied 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,” the official said.

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