Surfactant administration and prevention of neonatal RDS
THE CONTEXT
Surfactant replacement therapy (SRT) is used in preterm neonates with moderate to severe respiratory distress syndrome (RDS), alongside continuous positive airway pressure (CPAP*).
Surfactant preparations
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The source attributes the greater effectiveness of natural surfactants to their surfactant proteins B and A, which older artificial surfactants lack.
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New synthetic surfactants containing recombinant surfactant protein B are more effective than previous synthetic preparations.
Indications and benefits
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SRT can be used as rescue treatment for established RDS or prophylactically in neonates less than 28 weeks.
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A preterm neonate with respiratory distress initially receives CPAP. SRT is administered when severe RDS requires an inspired oxygen fraction of 40% or greater while on CPAP.
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SRT acts synergistically with CPAP, reduces the duration and level of respiratory support, and improves outcomes.
Administration approaches
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Traditionally, surfactant was given through an endotracheal tube in four or five boluses, with extubation after hours to days.
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The InSurE approach consists of intubation, surfactant administration, and rapid extubation to CPAP, avoiding mechanical ventilation.
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Administration through a thin catheter placed in the trachea under vision avoids the need for intubation and its complications.
Prevention
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Antenatal steroids reduce RDS, intraventricular hemorrhage, and mortality in preterm neonates.
Radiographic distinctions
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Transient tachypnea of newborn shows hyperinflation, prominent bronchovascular markings, and a visible horizontal fissure.
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Moderate to severe RDS shows homogeneous lung opacification obscuring the heart borders, with air bronchograms.
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Asymmetric patchy infiltrates with hyperinflation suggest meconium aspiration syndrome. The illustrated pneumonia involves one lung.