Surfactant in RDS

1. SURFACTANT
THERAPY
Presenter: Dr.Anurag Fursule
Teacher : Dr. G.Malini (HOD, Pediatrics , JLNHRC, Bhilai)

2. Introduction
 Respiratory failure secondary to surfactant
deficiency is a major cause of morbidity and
mortality in preterm infants.
 RCTs confirm that
-reduces mortality,
-decrease pulmonary air leak
-lowers the risk of CLD
-reduces death at 28 days of age

3. RDS
Primary
cause
HMD
Preterm
Birth(m.c
etiology)

4. Other Causes of RDS requiring
surfactant
IDM
MAS
Pneumonia
Pulmonary
Hemorrhage
• Surfactant
dysfunction
• Surfactant
inactivation

5. Why babies
need
surfactant??
Surfactant Production starts at 26 week and completed by 36 week

6. Composition

7. Types of Surfactant
 1.Natural
 2.Synthetic(exosurf,surfact)
 3.Modified natural(curosurf, neosurf, survanta)

8. Dosing
 phospholipid content:100mg/kg(larger dose
have good acute response and longer half life)
Decision of Repeat doses??
FIO2 > 0.3 No radiological
improvement(lun
g expansion)
MAP >7 cm of
H2O(still on MV)

9. What happens in HMD with
surfactant therapy?
before after

10. INSURE Protocol

11. PROPHYLACTIC VERSUS
RESCUE
SURFACTANT
 The meta-analysis of studies conducted before
routine application of CPAP demonstrated a
lower mortality rate and a decrease in the risk
of air leak in preterm infants receiving.

12. Animal derived vs Synthetic
 Both animal-derived and newer synthetic
surfactants with SP-B–like activity decrease
acute respiratory morbidity and mortality in
preterm infants with RDS (LOE 1).
 Animal derived surfactant are more desirable
despite incidence if IVH(grade 3 & 4
evidence).

13. Expected Complication of
therapy
 Pulmonary Hemorrhage and edema
 Apnea
 Bradycardia
 Blocked ETT
 Air leaks
 Possible infection
 ICH
 PDA
 Hypothermia

14. AN steroids and Surfactant
 Synergistic
 Reduce mortality & morbidity
 Reduce IVH
 Reduce air leaks

15. In Indian scenario what we
see…..
 Expensive
 Choice of surfactant depends upon
economical condition of parents and
availability.
 Hesitancy of about spending upon female
child.

16.  Thank you
Babies who received
surfactant in JLNHRC NNU

17. Thank
you!!!!