Use of Surfactant in Non-Ventilated Infants on Level 2
|Reviewed by Simon Rowley
Guideline on Exogenous Surfactant Use
for Considering Surfactant Use
- Clinical evidence of respiratory distress.
- Gestational age ≥32/40.
- Age less than 48 hours.
- Current chest radiograph available, consistent with
- Increasing ventilatory support requirements
- e.g.. FiO2 >40%, pH
<7.25, PaO2 <7.0kPa, PaCO2 >7.0kPa, (or
- An arterial line is not mandatory.
- Babies with RDS who also have significant apnoea should be considered
for transfer to Level 3.
- Discuss with Level 2 Specialist and Charge
- One to one nursing recommended for the
duration of the administration and observations.
- Inform Level 3 staff.
- Intubation drugs should preferentially be
used, acknowledging that this may prolong recovery time and some infants
will therefore require ongoing ventilation.
- Registrar or NS-ANP intubates and administers
appropriate dose, and ventilates using the Neopuff until stable or until the
baby clearly needs transfer to Level 3 for ongoing ventilation.
- Extubate to CPAP.
- If possible registrar/NS-ANP to remain on NICU for 30 minutes following extubation.
- Blood gas before and 30 minutes after .
- If no improvement post-surfactant, discuss with specialist on duty.
Options may include a repeat chest radiograph or ongoing positive pressure
H et al. Surfactant Therapy and Nasal Continuous Positive Airway
Pressure for Newborns with Respiratory Distress Syndrome. New Engl J Med Oct
20 1994; 331(16).