Management of Neonatal RDS: CPAP along with Surfactant Therapy

12 Oct, 11

Management of Neonatal RDS: CPAP along with Surfactant Therapy

Introduction

Avoiding intubation may avoid injury due to Mechanical Ventilation But...withholding surfactant may be detrimental to babies with NRDS¹

European Consensus Guidelines 2007 Recommend the use of CPAP with early rescue surfactant should be considered in babies with RDS in order to reduce the need for mechanical ventilation (A)*

This can be accomplished by using INSURE technique²

INSURE Technique (Intubate-Surfactant-Extubate to CPAP)

This method has been shown in randomized trials to reduce the need for mechanical ventilation.
The earlier in the course of RDS that surfactant is given the greater the chance of avoiding mechanical ventilation²

Study by Verder and Colleagues1

Method & Design

Aim-lf early surfactant therapy further reduces need for mechanical ventilation.
60 babies with NRDS with GA < 30 weeks of gestation being treated with nasal CPAP.
Randomized to receive surfactant when FiO₂ approximately 0.4 or continue on CPAP until they required FiO₂ of 0.6.
Attempts were made to extubate the baby shortly after surfactant had been given in both groups.

Results

Reduction in need for mechanical ventilation in 'Early surfactant' group

Reduction in mortality in 'Early surfactant' group

Conclusion

Preterm babies initially managed with nasal CPAP should be intubated and given surfactant if their oxygen requirement is increasing beyond an FiO₂ of 0.35-0.4.
It is possible that outcomes could be further improved if they are treated with surfactant even earlier.

Results

Of 35 babies in surfactant group, 33 successfully extubated at 1 hr and put back on CPAP

Significant Reduction in Need for Mechanical Ventilation in Surfactant Group

Conclusion

In babies with moderate-to-severe respiratory distress syndrome treated with nasal continuous positive airway pressure, a single dose of surfactant reduced the need for subsequent mechanical ventilation.

References

1. J. perinatal med. 2007; 35: 175-186
2. Paediatric respiratory reviews 2003; 4: 2-8