Criteria for Considering Surfactant Use

Clinical evidence of respiratory distress.
Gestational age ≥32/40.
Age less than 48 hours.
Current chest radiograph available, consistent with RDS.
Increasing ventilatory support requirements
- e.g.. FiO2 >40%, pH <7.25, PaO₂ <7.0kPa, PaCO₂ >7.0kPa, (or A/a < 0.22).
An arterial line is not mandatory.

Unlikely Candidates

Babies with RDS who also have significant apnoea should be considered for transfer to Level 3.

Discuss with Level 2 Specialist and Charge Nurse.
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 ventilation.

1	Verder 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).