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Surfactant in RDS

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Surfactant in RDS

Publicada em: Saúde e medicina
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Surfactant in RDS

  1. 1. SURFACTANT THERAPY Presenter: Dr.Anurag Fursule Teacher : Dr. G.Malini (HOD, Pediatrics , JLNHRC, Bhilai)
  2. 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. 3. RDS Primary cause HMD Preterm Birth(m.c etiology)
  4. 4. Other Causes of RDS requiring surfactant IDM MAS Pneumonia Pulmonary Hemorrhage • Surfactant dysfunction • Surfactant inactivation
  5. 5. Why babies need surfactant?? Surfactant Production starts at 26 week and completed by 36 week
  6. 6. Composition
  7. 7. Types of Surfactant  1.Natural  2.Synthetic(exosurf,surfact)  3.Modified natural(curosurf, neosurf, survanta)
  8. 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. 9. What happens in HMD with surfactant therapy? before after
  10. 10. INSURE Protocol
  11. 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. 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. 13. Expected Complication of therapy  Pulmonary Hemorrhage and edema  Apnea  Bradycardia  Blocked ETT  Air leaks  Possible infection  ICH  PDA  Hypothermia
  14. 14. AN steroids and Surfactant  Synergistic  Reduce mortality & morbidity  Reduce IVH  Reduce air leaks
  15. 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. 16.  Thank you Babies who received surfactant in JLNHRC NNU
  17. 17. Thank you!!!!

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