NRP and Surfactant Administration

Question 1

When do we give surfactant to a non-ventilated infant?

Answer 1

If they are already receiving CPAP >5 cmH2O AND:
1. FiO2 requirements >40% to maintain 88-92 sats
2. Increased WOB even with CPAP
3. PaCO2 >65mmHg or pH <7.15
4. Poor perfusion requiring colloid/crystalloid or inotropes
5. Apnea unresponsive to caffeine or stimulation

Question 2

When do we give surfactant to an intubated infant?

Answer 2

1. radiological evidence of RDS (ground glass on CXR)
   - requiring FiO2 >30% or before transport
2. meconium aspiration syndrome or pneumonia requiring more than 50% FiO2
3. Pulmonary hemorrhage leading to deterioration

Question 3

How long should it take to instill surfactant?

Answer 3

10-15 seconds

Question 4

How long should the ETT not be suctioned for after instillation of surfactant?

Answer 4

About 6 hours

Question 5

What are our target sats after giving surfactant?

Answer 5

80-95%

Question 6

When should we consider retreatment for surfactant and how long after the first dose should we give it?

Answer 6

If they continue to have persistent increased oxygen requirements of 30% or greater, and we should wait 4-6 hours to give it again.

Question 7

What is the dose for BLES?

Answer 7

5 ml/kg, divided into 2 aliquots

Question 8

What is the dose for Curosurf?

Answer 8

2.5 ml/kg, divided into 2 aliquots

Question 9

What equipment do you need for surfactant administration?

Answer 9

T-piece resuscitator, flow inflating bagger, 10 ml syringe, ballard multi-system catheter, a large bore needle, and the surfactant