Surfactant Use in Resuscitation

dr. Adhi,Sp.A (K)

Surfactant
 Profilactic Surfactant

Surfactant : Indication
Profilactic Surfactant
• Surfactant administration to infants at high risk of developing
RDS for the primary purpose of preventing worsening RDS
rather than treatment of established RDS  surfactant
administration in the delivery room before initial
resuscitation efforts or the onset of respiratory distress 
most commonly, after initial resuscitation but within 10 to 30
minutes after birth.
• Give to all neonate less than 28
weeks gestation before they got
respiratory distress syndrome
 Surfactant Rescue

Surfactant : Indication
Surfactant Rescue
• Surfactant is given only to preterm
infants with established RDS 
Rescue surfactant is most often
administered within the first 12
hours after birth
• When specified threshold criteria
of severity of RDS are met.
 Surfactant Rescue : Specific Criteria (1)

Surfactant : Indication

Surfactant Rescue : Specific

Criteria

• Intubated preterm neonates

who needs FiO2 ≥40% & PIP
up to 20 cmH20 to maintain
SpO2 88 – 92 %
 Surfactant Rescue : Specific Criteria (2)

Surfactant : Indication
Surfactant Rescue : Specific Criteria
Preterm neonates with CPAP with clinical findings of CPAP Failure
1. Deterioration of respiratory distress  apneu
2. Severe retraction with Downe Score ≥ 6
3. Already with CPAP  PEEP 8 cmH2O and FiO2 ≥40%, but still show signs of respiratory
distress
4. Blood Gas Analysis (if possible):
–pH < 7,25
–pO2< 50 mmHg (with FiO2>40%)
–pCO2>60 mmHg
–BE>-10
 Surfactant Administration
• Invasive
– Intubate and mechanical ventilator
– INSURE Methode
• Minimally invasive
– Using Canulla
– Using Small diameter tube
– Using LMA
• Non Invasive
– Using Aerosol
METODE INSURE
METODE MIST
 METODE MIST
• Metode HOBART
 METODE MIST
• Metode Cologne
 MIST VS INSURE

• In the Take Care trial, surfactant administration via a thin catheter

was compared in a randomized controlled trial versus the classical
INSURE technique in preterm infants less than 32 weeks’ gestation.
• Compared with INSURE, the Take Care group had a lower rate of
intubation less than 72 hours (30% vs 45%; P < .02), a significantly
shorter duration of both CPAP and MV, somewhat surprisingly, a
lower rate of BPD (10% vs 20%; P = .009)
A recent meta analysis of early (within 2 hours) versus delayed surfactant treatment
concluded that risks of
mortality (RR 0.84; 95% CI 0.74–0.95),
air leak (RR 0.61; 95% CI 0.48–0.78),
chronic lung disease (RR 0.69; 95% CI 0.55– 0.86), and
chronic lung disease or death (RR 0.83; 95% CI 0.75–0.91)
There were no differences in other complications of prematurity.
Participants: 26 –32 weeks (600g –1500g) with RDS beractantwas
administered in 3 groups Group 1 (4 positions), group 2 (2 positions), group 3
(1 position)
No difference in application related issue as well as risk factors
Result: no statistically difference in ventilation support needs complications
(pneumothorax, need for resuscitation, perforation of trachea / esophagus)
extubationsuccess rate NEC, CLD, ROP, IVH, PDA, sepsis, pulmonary
hemorrhage•Need for rehospitalization within 1 month after discharge
THANK YOU