In a preterm neonate with signs of respiratory distress syndrome, what are the main indications for surfactant therapy, and what are common methods of administration?

In a preterm neonate with signs of respiratory distress syndrome, what are the main indications for surfactant therapy, and what are common methods of administration?

• A. Diffuse granular pattern on chest radiograph with respiratory distress and FiO2 needs; administer intratracheal surfactant via INSURE or as prophylaxis coverage; monitor oxygenation and ventilation.
• B. Administer surfactant intravascularly only if FiO2 requirement persists beyond 60%.
• C. Surfactant is always given intravenously for RDS.
• D. Surfactant is used only in meconium aspiration syndrome.

Answer: (A)

Surfactant therapy is indicated when a preterm infant shows signs of respiratory distress syndrome due to surfactant deficiency and needs increasing oxygen support. A chest X-ray with a diffuse granular, ground-glass pattern and air bronchograms, together with distress and a rising FiO2 requirement, points to RDS where surfactant can make a crucial difference by improving lung compliance and oxygenation. The surfactant is delivered directly into the airway through the trachea, most commonly using methods like INSURE (intubate, administer surfactant, then extubate to CPAP) or prophylactic coverage in high-risk infants; newer approaches like less invasive techniques (LISA) also aim to place surfactant via the airway without full intubation. After administration, continuous monitoring of oxygenation and ventilation is essential to guide ongoing respiratory support. Surfactant is not given intravenously, and its use is not limited to meconium aspiration syndrome.

Surfactant therapy is indicated when a preterm infant shows signs of respiratory distress syndrome due to surfactant deficiency and needs increasing oxygen support. A chest X-ray with a diffuse granular, ground-glass pattern and air bronchograms, together with distress and a rising FiO2 requirement, points to RDS where surfactant can make a crucial difference by improving lung compliance and oxygenation. The surfactant is delivered directly into the airway through the trachea, most commonly using methods like INSURE (intubate, administer surfactant, then extubate to CPAP) or prophylactic coverage in high-risk infants; newer approaches like less invasive techniques (LISA) also aim to place surfactant via the airway without full intubation. After administration, continuous monitoring of oxygenation and ventilation is essential to guide ongoing respiratory support. Surfactant is not given intravenously, and its use is not limited to meconium aspiration syndrome.