Exogenous Surfactant Administration
Management guidelines for students, interns and registrars on a variety of routine and emergency situations in our neonatal service at Tygerberg Children’s Hospital. Published in 2014.
Indication
Respiratory distress syndrome needing FiO2 ≥0.35 (35%) O2
Time of administration
Preferably within 2 hours after birth.
Method of administration
Route of intubation (oral or nasal) will be dictated by the doctor’s experience. If orally, an introducer or stylet should not be used.
An assistant must always be present to instill the surfactant. Do not “bag or neopuff” the surfactant down the trachea. Intubation must be an aseptic procedure.
Administer Atropine 0.02mg/kg IV before intubation
- Use a 2mm ET tube with a side-port; or a ET tube with a stomach tube cut to a length approximately 5mm shorter than ET tube.
Instill surfactant (with 0.5 ml air proximal in syringe) as a bolus through the ET side-port, otherwise through the stomach tube via the ET tube into trachea. - The surfactant may also be administered gradually as 1 – 2 ml/kg boluses (pending on prescribed dosage per kg) over 1 min via a double lumen ET tube with baby’s head placed in the midline.
The baby does not have to be turned during this method of surfactant administration. - Placing a nasogastric tube (Size Fg/CH 5 or 6) and cut short (to the length of the ET tube) with a sterile blade) through the vocal cords is also acceptable
If 1st intubation attempt is unsuccessful, sedate baby with Ketamine 1-2 mg/kg/IV and intubate.
If 2nd intubation attempt is unsuccessful, a senior person must assist, otherwise abort procedure and put baby back on nCPAP.