When a newborn baby is born prematurely (Less than 37 week), he/she may need surfactant therapy. The reason behind this is that such babies do not have maturity in the lungs and the substance surfactant in the lungs is minimal in such babies.
The surfactant’s function is to inflate the lung passage so that the baby can breathe. Babies born prematurely have very low levels of surfactant so they need surfactant .
Let’s understand meaning of Surfactant replacement therapy.
What is a surfactant?
Surfactant is a type of pulmonary substance composed of phospholipids and proteins. Surfactant spreads on the surface of airways of the lungs, which reduces the surface tension in the airways and keeps the airways dilated. Because of this the baby does not have trouble breathing.
In which disease is deficiency of surfactant seen?
Surfactant deficiency is seen in infants with respiratory distress syndrome. Some full term babies having meconium aspiration syndrome, pulmonary hemorrhage, as well as pneumonia and bacterial infections may show surfactant deficiency. Such newborns need to be cared very carefully.
Why it is important to give surfactant therapy immediately after birth?
After the baby is born, the baby’s lungs contain a small amount of fluid. If surfactant therapy is given as early as possible, the surfactant spreads with that substance to almost the entire lungs, thus reducing the tension on the surface of the respiratory tract.
Delaying surfactant therapy for baby can damage his/her lungs and cause inflammatory substances to build up in the lungs. It also causes bleeding from the veins. Therefore, receiving surfactant therapy immediately after birth increases the chances of saving the baby’s life.
For what reasons is surfactant therapy given?
Surfactant is given to a newborn baby who has the following problems
- If there is respiratory distress syndrome on examination and according to radiographic evidence
- If the newborn is less than 32 weeks old
- If the newborn baby weighs less than 1.3 kg
- If the newborn is intubated and FiO2 requirement is more than 40%
- If there is meconium aspiration syndrome
- If there is bleeding in the lungs
How is surfactant therapy given?
- Surfactant therapy is given by inserting a tube into the trachea of respiratory tract.(endotracheal intubation).
- Surfactant therapy requires a doctor and an experienced nurse
- The baby is monitored while giving surfactant. This helps to understand the heart rate, respiratory rate and oxygen level of the baby.
- After inserting the tube into the trachea, it is ensured that breathing is done on both sides of the chest. X-rays can also be taken to find out the position of the tube.
- Some babies have persistent positive airway pressure in which a tube is inserted into the trachea, meaning intubation is done then a surfactant is given and then the tube is removed. This process is called INSURE technique.
- This procedure is done by the doctor and nurse who give the surfactant after cleaning the hand and putting the glove on the hand.
- The surfactant temperature must be not too cool and not too hot.
- Feeding tubes are used to give the surfactant. The tube is inserted upto the end of the endotracheal tube and the drug is taken into a syringe attached to feeding tube and with the help of the syringe surfactant is released in trachea and respiratory airways.
- While giving surfactant therapy, the baby is lying down completely horizontally.
- Surfactant therapy is given within a minute.
- Sometimes the endotracheal tube gets blocked while giving the surfactant. At such times, the trachea has to be cleared by stopping the giving of surfactant.
- The baby is kept on CPAP or ventilator as needed.
- Baby’s vitals are monitored by a doctor for some time after giving surfactant.
- Endotracheal tube suction should be avoided for 2 hours after giving surfactant therapy.
What are the problems with giving surfactant therapy?
When giving surfactant, there are problems like low heart rate, lack of oxygen in the baby’s body and blockage of endotracheal tube. Problems like pneumothorax, pulmonary hemorrhage can also appear in the baby.
What are the benefits of giving surfactant therapy?
The benefits of giving surfactant therapy in every baby are more or less visible.
The response to surfactant depends on the following factors.
- At what time therapy was given
- Illness of the baby
- Maturity of the baby’s lungs
Timely treatment is very beneficial. So the following types of benefits appear.
- The baby’s breathing difficulties are reduced
- Reduces the accumulation of air in the chest (pneumothorax)
- Surfactant therapy increases the chances of the baby surviving.
What type of surfactant injection are used for surfactant therapy?
Surfactants like Survanta, Infasurf, Curosurf are used for giving surfactant therapy. Surfactants are given to the baby according to the baby’s needs.
- Survanta inj surfactant can be given four times at intervals of six to twelve hours.
- Infasurf inj surfactant can be given three times at intervals of twelve hours.
- Curosurf inj surfactant can be given twice at intervals of twelve hours.
Timely treatment is always beneficial. A baby needs surfactant therapy as early as possible,so that baby recovers very rapidly. It can also save the life of the baby, so parents should make a decision as soon as possible and inform the doctor about the decision to give surfactant replacement therapy.
It is a very delicate moment for parents to have their newborn treated in NICU. But if the necessary treatment is given in time, the future of the baby is better, so it is always beneficial for the parents to be firm and make the right decision.