Flashcards in Recommendations for neonatal surfactant therapy Deck (13):
What are the benefits of surfactant therapy?
1. Reduced mortality
2. Reduced deficits in oxygenation
3. Reduced pneumothorax and pulmonary interstitial emphysema
4. Reduced duration of ventilatory support
5. Increases likelihood of survival without BPD by improving survival not reducing incidence of BPD
6. Reduced LOS hospital
7. Reduced costs of NICU treatment
What are the indications for surfactant therapy?
1. Intubated infants with RDS
2. Intubated infants with meconium aspiration syndrome requiring >50% oxygen
3. Sick newborn infants with pneumonia and an OI > 15
4. Inntubated newborn infants with pulmonary hemorrhage leading to clinical deterioration
No recommendations for lung hypoplasia or congenital diaphragmatic hernia
What are the risks of exogenous surfactant therapy?
1. Bradycardia during instillation
2. Hypoxemia during instillation
3. Blockage of the ETT
4. Increased pulmonary hemorrhage but not death related to pulmonary hemorrhage
5. Hyperventilation with low PCO2 and lung distension can occur if pressures are no reduced
6. Potential transfer of prions
Which is better natural or synthetic surfactants?
Which is better surfactant prophylaxis or rescue therapy for preterm infants with RDS?
Infants who are at significant risk of RDS should receive prophylactic natural surfactant therapy as soon as they are stable within a few minutes after intubation
How should surfactant replacement therapy be given?
Instill liquid form via ETT
Either in one bolus or over aliquots
What dosage should be used?
Up to 120mg/kg for first dose
Should multiple or single doses of surfactant be used?
Infants with RDS who have persistent or recurrent oxygen and ventilatory requirements within the first 72 h of life should have repeated doses of surfactant. Administering more than three doses has not been shown to have a benefit
What are the criteria for, and timing of, retreatment?
Retreatment should be considered when there is a persistent or recurrent oxygen requirement of 30% or more and it may be given as early as 2 h after the initial dose or, more commonly, 4 h to 6 h after the initial dose
How should ventilatory management after surfactant therapy be approached?
Options for ventilatory management that can be considered after prophylactic surfactant therapy include very rapid weaning and extubation to CPAP within 1h
If postnatal surfactant therapy is available does the infant still need to use antenatal steroids?
According to established guidelines, mothers at risk of delivering babies with less than 34 weeks gestation should be given antenatal steroids regardless of the availability of postnatal surfactant therapy
Should surfactant therapy be given before the transport of a baby with RDS?
1. Intubated infants with RDS should receive exogenous surfactant therapy before transport
2. Centres administering surfactant therapy to newborn infants must ensure the continuous on-site availability of personnel that are competent and licensed to deal with the acute complications of assisted ventilation and surfactant therapy