Surfactant replacement therapy in neonates

Exogenous surfactant therapy has become established as a standard part of the management of neonates with RDS. Both natural and synthetic surfactants lead to decreased mortality and morbidity, with natural surfactants having a definite edge. Surfactant administered prophylactically to preterms has benefits compared with rescue surfactant given to infants with established RDS. Early selective rescue treatment has benefits over later rescue treatment in RDS. The use of 2–4 multiple doses of surfactant is more beneficial than the use of a single dose. Adverse immediate effects of surfactant therapy are infrequent as also long-term complications. Surfactant usage for RDS in India is increasing now with better availability and costing. However strict guidelines and policies need to be enforced so that its usage is restricted to suitably trained physicians in approved level 2 or 3 neonatal units with adequate facilities. Also it should be offered more to babies with RDS with birth weights greater than 1000 gm as chances of ‘intact survival’ would be better in them. More so, a dedicated neonatal team, intense monitoring, effective infection control, antenatal steroid therapy, gentle ventilation, aggressive nutrition and humane approach are crucial in treating preterms with RDS. Surfactant therapy is a well proven adjunct in improving their survival.