Administration of Surfactant

Administering surfactant into the lungs of neonates has resulted in significant improvement in the outcome of premature neonates.^{[87] [88] [89] [90]} The incidences of pulmonary gas leaks, hyaline membrane disease, deaths, bronchopulmonary dysplasia, and pulmonary interstitial emphysema are lower after surfactant administration. Frequently, surfactant is given as a liquid (i.e., 5 mL of fluid per kilogram given into the trachea at birth), which may briefly reduce oxygen saturation. Subsequently, the SaO₂ increases rapidly in most instances, as does the compliance of the lung. The latter may lead to overinflation of the lung and the development of lung injury or a pulmonary gas leak if ventilation is not reduced.

There has been a trend to treat premature infants with continuous positive airway pressure (CPAP) shortly after birth in an attempt to reduce the use of tracheal intubation and mechanical ventilation. The data indicate that it is possible to reduce the incidence of mechanical ventilation but not the occurrence of CNS hemorrhage or chronic lung disease.^[91] There is no difference in the duration of oxygen administration or chronic lung disease. Further studies are needed to determine whether this form of respiratory support is more effective than tracheal intubation, especially because many babies treated with nasal CPAP immediately after birth do not receive surfactant.