Techniques and criteria for administering surfactant
| Author | Dose of surfactant | Technique of giving surfactant | Criteria for intubation prophylactic group | Time of prophylactic dose | Criteria for intubating babies in the rescue group | Criteria for giving surfactant to the rescue group | Criteria for additional doses for both groups |
|---|---|---|---|---|---|---|---|
| Dunn10 | 25 mg/ml, 24-26 wk - 3 ml, 27-29 wk - 4 ml | Catheter down the endotracheal tube in 3 aliquots. Bag ventilation with each aliquot | Elective at birth | Before the first breath, breathing prevented before surfactant | Apnoea, needing oxygen, has RDS. Unit policy to ventilate all babies <30 weeks | All babies treated no later than 6 hours unless no evidence of RDS | Up to 3 doses in first 5 days, given if FIO2 increase by 0.1 over lowest baseline |
| Kendig11 | 90 mg in 3 ml | Catheter down the endotracheal tube in 4 aliquots. Bag ventilation with each aliquot | Elective at birth | Within seconds of intubation | Not stated | If chest x ray shows RDS and FIO2>0.4, mean airway pressure >7.0cm H2O either or both. Hand ventilated before surfactant given | At intervals of 12 to 24 hours if FIO2 >0.4, mean airway pressure >7 cm H2O or both |
| Egberts12 | 200 mg/kg, 2.5 ml/kg | With a catheter down the endotracheal tube in one bolus | Elective at birth | Within 10 minutes | Intubated at birth | If ventilated and FIO2 >0.6 at 6 to 24 hours | Second dose at 6 hours or rescue treatment if FIO2 >0.6 |
| Kattwinkel 13 | 4.5 ml per dose, 150 mg per dose | Instilled into the trachea | Elective as soon as practical | By 5 minutes | Chest x ray showed RDS and FIO2⩾0.3 | Chest x ray shows RDS and FIO2>0.3 and intubated. Given straight after intubation | Repeated if FIO2>0.6 and MAP>10 cm H2O |
| Walti14 | 100 mg/kg, 1.25 ml/kg | With a catheter down the endotracheal tube in 2 aliquots. | Elective at birth | By 15 minutes | If PaO2 less than 6.6 kPa (50 mm Hg) with FIO2⩾ 0.3 and/or PaCO2 >7.3 kPa (55 mm Hg) | Chestx ray shows RDS and PaO2/FIO2<150 mm Hg (20 kPa) at mean airway pressure of 8 cm H2O | Up to 3 doses in 48 hours. If PaO2/FIO2 <150 mm Hg (20 kPa) |
| Bevilacqua 15 | 200 mg/kg, 2.5 ml/kg | With a catheter down the endotracheal tube as a bolus | At birth on clinical grounds | By 10 minutes | According to the routine of each unit | Chest x ray shows RDS and needing ventilation irrespective of inspired oxygen | Up to 3 doses in 48 hours. If PaO2/FIO2 <150 mm Hg (20 kPa) |