Single dose surfactant early rescue therapy in respiratory distress syndrome-experience and outcome at a tertiary care centre

Keerti Swarnkar, Manish Swarnkar


Background: Neonatal respiratory distress syndrome (RDS) is a progressive respiratory failure that is caused primarily by a deficiency of pulmonary surfactants (PS). We undertook a prospective study to evaluate outcomes of neonatal respiratory distress syndrome (RDS) patients treated with early rescue pulmonary surfactant.

Methods: This was a prospective cross sectional study conducted at level III NICU. A total of 47 eligible  patients out of 142 diagnosed RDS on chest x-ray or FiO2 ≥40 was needed to reach SpO2 between 85 and 93%  received early recue surfactant therapy (within 2hrs of life) and  maternal ,neonatal and clinical data was analysed using SPSS software.

Results: In this study prevalence of RDS amongst neonates admitted in NICU was 16.4%, early rescue surfactant therapy could be given only to 47 cases. There was male predominance (2.62:1). Mean age of administration of surfactant was 1.30±0.8 hr and Antenatal steroid was given in only 21.3% of mothers. Fraction of inspired oxygen concentration (Fio2) requirement also significantly decreases before and after therapy (p value˂0.0001) at 6,12, and 24 hrs. PEEP also shows decreasing trend at 24 hrs (p value ˂0.05). Sepsis was the commonest complication leading to mortality.

Conclusion: Implementation of early rescue administration of surfactant in infants at high risk for developing RDS in neonatal ICU is a safe and effective modality of respiratory support which decreases ventilatory requirements, improves respiratory status, and causes early extubation.



Respiratory distress syndrome, Early rescue, Surfactant, Ventilatory parameters, Fraction of inspired oxygen

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Rebello CM, Precioso AR, Mascaretti RS. A multicenter, randomized, double-blind trial of a new porcine surfactant in premature infants with respiratory distress syndrome. Einstein (São Paulo). 2014;12(4):397-404.

Enhörning G, Robertson B. Lung expansion in the premature rabbit fetus after tracheal deposition of surfactant. Pediatrics. 1972;50(1):58-66.

Femitha P, Joy R, Adhisivam B, Prasad K, Gane BD, Bhat V. Surfactant replacement therapy (SRT) in respiratory distress syndrome (RDS). Curr Pediatr Res. 2012;16(2):134-6.

Lemons L, Blackmon LR, Kanto W, MacDonald HM, Miller C, Papile L, et al. Surfactant replacement therapy for respiratory distress syndrome. Pediatrics. 1999;103(3):684-5.

Schwartz RM, Luby AM, Scanlon JW, Kellogg RJ. Effect of surfactant on morbidity, mortality, and resource use in newborn infants weighing 500 to 1500 g. New England Journal of Medicine. 1994;330(21):1476-80.

Engle WA. Surfactant-replacement therapy for respiratory distress in the preterm and term neonate. Pediatrics. 2008;121(2):419-32.

Barros FC, Bhutta ZA, Batra M, Hansen TN, Victora CG, Rubens CE. Global report on preterm birth and stillbirth (3 of 7): evidence for effectiveness of interventions. BMC pregnancy and childbirth. 2010;10(Suppl 1):S3.

Paul V. Neonatal morbidity and mortality: report of the national neonatal and perinatal database. Indian pediatrics. 1999;36(2):167-9.

Vidyasagar D, Velaphi S, Bhat VB. Surfactant replacement therapy in developing countries. Neonatology. 2011;99(4):355-66.

Kendig JW, Notter RH, Cox C, Reubens LJ, Davis JM, Maniscalco WM, et al. A comparison of surfactant as immediate prophylaxis and as rescue therapy in newborns of less than 30 weeks' gestation. New England Journal of Medicine. 1991;324(13):865-71.

Kumar P, Kumar R, Narang A. Spectrum of neonatal respiratory distress at PGI. Bull NNF. 1999;13(4):8-11.

Bhakoo O. Assisted ventilation in neonates: The Indian perspective. Indian pediatrics. 1995;32(12):1261-4.

Jobe AH, Mitchell BR, Gunkel JH. Beneficial effects of the combined use of prenatal corticosteroids and postnatal surfactant on preterm infants. American journal of obstetrics and gynecology. 1993;168(2):508-13.

Khan EA, Hashmey I. Surfactant use in premature neonates< 37 weeks gestation: Experience and outcome at a tertiary care hospital. JPMA. 2015;65(486).

Seger N, Soll R. Animal derived surfactant extract for treatment of respiratory distress syndrome. Cochrane Database Syst Rev. 2009;2(2).

Halliday H. Surfactants: past, present and future. Journal of Perinatology. 2008;28:S47-S56.

Soll R. Synthetic surfactant for respiratory distress syndrome in preterm infants. Cochrane Database of Systematic Reviews. 1998;3.

Wood AJ, Jobe AH. Pulmonary surfactant therapy. New England Journal of Medicine. 1993;328(12):861-8.

Svenningsen NW. Pulmonary functional residual capacity and lung mechanics in surfactant-treated infants. Semin Perinatol. 1992;16(18):181-5.

Goldsmith LS, Greenspan JS, Rubenstein SD, Wolfson MR, Shaffer TH. Immediate improvement in lung volume after exogenous surfactant: alveolar recruitment versus increased distention. The Journal of pediatrics. 1991;119(3):424-8.

Bahadue FL, Soll R. Early versus delayed selective surfactant treatment for neonatal respiratory distress syndrome. Cochrane Database Syst Rev. 2012;11(11).

Singh M, Deorari A, Aggarwal R, Paul V. Assisted ventilation for hyaline membrane disease. Indian pediatrics. 1995;32(12):1267-74.

Tsakalidis C, Kourti M, Karagianni P, Rallis D, Porpodi M, Nikolaidis N. Early rescue administration of surfactant and nasal continuous positive airway pressure in preterm infants< 32 weeks gestation. Indian pediatrics. 2011;48(8):601-5.

Narang A, Kumar P, Dutta S, Kumar R. Surfactant therapy for hyaline membrane disease: the Chandigarh experience. Indian pediatrics. 2001;38(6):640-5.

Bae C-W, Hahn W-H. Surfactant therapy for neonatal respiratory distress syndrome: a review of Korean experiences over 17 years. Journal of Korean medical science. 2009;24(6):1110-8.

Al Umran K, Yaseen H. Cost-effectiveness of surfactant replacement therapy in a developing country. Journal of Tropical Pediatrics. 1997;43(3):167-9.

Tubman T, Halliday H, Normand C. Cost of surfactant replacement treatment for severe neonatal respiratory distress syndrome: a randomised controlled trial. Bmj. 1990;301(6756):842-5.