- Male sex
- Caucasian race
- Maternal diabetes
- Perinatal asphyxia
- C-section without labor
- Thoracic malformations
- Genetic disorders of surfactant production
- Tachypnea, grunting, and retractions
- O2 requirement tends to increase over the first 48 h if not treated
- CXR: diffuse, fine granular densities that develop during the first few hours of life
- Hypotension (treat as appropriate)
- A PDA can lead to poor recovery from RDS, and closure should be considered if patient is 3–4 d old with hemodynamic compromise or continued RDS with poor weaning from mechanical ventilation
- Many centers start CPAP and do not give “prophylactic” surfactant therapy.
- Many formulations are available. Check with your institution to determine the appropriate dosage/interval/number of doses.
- Consider prophylactic surfactant therapy as soon as clinically feasible for infants <27 wk gestation who require intubation.
- For all other infants, early rescue surfactant (within 1–2 h after birth) is indicated for worsening respiratory distress on exam or increasing Fio2 requirement above 30%–40%.
- Lack of antenatal corticosteroid therapy in infants 24–34 wk gestation
- ABG: hypoxia, hypercarbia, mild metabolic acidosis, ± elevated lactate
- ABG: should be checked within 30–60 min of surfactant therapy or with changes in ventilator settings
- Temperature: neutral thermal environment should be maintained
- Antibiotics: RDS is difficult to distinguish from pneumonia and sepsis; consider appropriate cultures and initiate broad-spectrum antibiotics (ie, ampicillin and gentamicin) for 48 h
- Ensure appropriate ETT position and equal lung inflation prior to giving surfactant.
- Dosage: 4 mL/kg (Survanta dosing) per ETT q4–6h for up to four doses.
- Pulmonary hemorrhage can be seen after surfactant therapy; this is thought to result from rapid change in lung compliance.
- O2 saturations alarms should be 85%–97% if ≥1250 g and 85%–93% if <1250 g to limit exposure to high Fio2 (these are oximetry alarm limits, not targets; targets are ...
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