I would love to hear your local practice in regards to repeated doses of surfactant in neonates with respiratory distress?

The study publish by Soll in cochrane showed benefits of multiple vs single dose, but the RCT were done in the 90's when gentle ventilation and antenatal steroids were not standard in the NICU!

What do Neos across the world do in this regard?

If you do repeat the treatment, what is your criteria? GA, time after birth, degree of respiratory distress or respiratory modality?

Thanks for you feedback on this interesting topic. I am a neo neo trained in the post surfactant era, support trial and nCPAP to treat very small preemies with RDS, so is not hard for me to incorporate these new modalities in our practice!

If you do not use repeated doses of surf, can you provide any reference that support this practice?

Thanks

Interesting question.

I work in a level-2 unit now where we do INSURE procedures, and it is rare that infants need more respiratory support than cpap after the first dose of surfactant, given that "our" babies are born from 28 weeks.

I believe though that the level-3-units @ Karolinska sometimes give 2 doses of surfactant, at least we read this in the records in some babies transferred to us for level-2-care. And I guess they use the same approach as when I was there, i.e. a 2nd dose can be given in more severe RDS when FiO2 and ventilatory settings "backlash" after the first dose AND x-ray still indicate RDS (and not other kind of lung disease).

 

In other words, I believe they do not have clear-cut guidelines in terms of gestational age etc, but tailor a 2 course of surfactant therapy in each individual case.

We give max 3 doses of surfactant. The third dose would only be given if we had seen an effect with the second dose and oxygen levels, ventilator settings were creeping up again. Happens very rarely though

We do not have any guidelines for that though.

We also give repeat surfactant dose if fio2 requirement above 40% or persistanly increasing.most of babies who required repeat surfactants are extreme preterms.as such no guidelines to wait for particular time.we repeat if no response in next 2-3 hrs.n max.3 doses.

Thanks for your responses.

We have changed our practice from multiple doses to single dose, maximum 2

Doses

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Dr. Vijayashankara, would you please, explain a bit more why your practice was change from multiple to a single dose of surfactant?

Thanks

New consultant arrived!!!!

And of course CPAP with or without one dose of surfactant has become regular practice, extreme preterm term babies who needs intubation and ventilation, second dose are sometimes are ordered.

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