Management of Respiratory Distress Syndrome with a Single Dose of Surfactant; A Study of Early Rescue Therapy

Management of Respiratory Distress Syndrome with a Single Dose of Surfactant

Abstract

Background: Deficiency of pulmonary surfactant is the primary cause of neonatal respiratory distress syndrome which leads to progressive respiratory failure. Two fundamental hindrances to ideal utilize were non affordability by the patient and non-accessibility during crisis hours. Distinctive procedures of surfactant instillation incorporate prophylactic methodology and early rescue approach. The present study was designed to survey and offer our experience of early rescue surfactant use in babies with respiratory distress syndrome. Subjects and Methods: Exosurf  was administered over a period of five to ten minutes through a side port adapter. FiO2 and ventilator settings were immediately adjusted to maintain adequate blood gases (PaO2 50-70 mm Hg, PaCO2 40-50 mm Hg and pH>7.25) with the lowest possible peak inspiratory pressures and FiO2. After surfactant administration for the first six hours, routine endotracheal tube suctioning was avoided. Blood gases are done thirty minutes post surfactant and thereafter for change in ventilator parameters or as per clinical requirement. Results: ABG parameters although showed an improved trend before and after surfactant therapy but was not statistically significant. Among 42 neonates on surfactant therapy 8 neonates could not survived. Mortality was 100% for the neonate less than 28 wks. However, overall mortality was 19.04% and was inversely related to gestational age. Fio2 requirement at 24 hr was significantly lower in survivor group. Mean duration of ventilation was 104.921.8 and 24% of mother received antenatal steroid in survivor group. Sepsis was the major complication leading to mortality. Conclusion: Findings of the present study suggest that administration of surfactant was related with reduced ventilatory necessities, enhanced respiratory status and early extubation. The most extreme effect on survival was seen in preterm babies (28-33weeks) and low birth weight (?1500gm). Sepsis is an essential confusion and its essence; alongside a high respiratory distress syndrome score at intubation are critical indicators of mortality.