SURFACTANT THERAPY. The Egyptian Consensus on the Management of Neonatal Respiratory Distress Syndrome 2017



1. Babies with RDS should be given a natural surfactant preparation (A1).

2.A policy of early rescue 

surfactant (within 2 hours of birth) should be standard (A1) but there are occasions when surfactant should be administered in the delivery suite, such as those who require intubation for stabilization (B1).

3 Babies with RDS should be given rescue surfactant early in the course of the disease. A suggested protocol would be to treat babies ≤26 weeks’ gestation when Fi O 2 requirements >0.30 and babies >26 weeks’ when Fi O 2 requirements >0.40 (B2).

4. Utilizing the INSURE technique, or other non-invasive techniques, is recommended. More mature babies can often be extubated to CPAP or nasal intermittent positive pressure ventilation (NIPPV) immediately following surfactant administration (B).

5.INSURE should be considered for infants who are failing on CPAP (A2).

6. LISA or MIST may be used as alternatives to INSURE for spontaneously breathing infants (B2).

7.A second and sometimes a third dose of surfactant should be administered if there is evidence of ongoing RDS such as persistent oxygen requirement and need for MV (A1).

8. At least 100 mg/kg of phospholipid is required, but there are pharmacokinetic and clinical data suggesting that 200 mg/kg has a longer half-life (A1).

  • Qual­i­ty of evi­dence
   – High qual­i­ty A    – Mod­er­ate qual­i­ty B    – Low qual­i­ty C    – Very low qual­i­ty D MODIFIED FROM: Euro­pean Con­sen­sus Guide­lines on the Man­age­ment of Res­pi­ra­to­ry Dis­tress Syn­drome – 2016 Update Spon­sored by: abb­vie EGYPT Shar­ing pro­fes­sors:
  • Prof Abdel Rah­man El Mashad (Tan­ta univ)
  • Prof Afaf Kor­raa (Azhar univ)
  • Prof El Sayed Kha­laf (Port fouad hosp, min­istry of health)
  • Prof Iman Eskan­der (Cairo univ)
  • Prof Hes­ham Abdel Hady (Man­soura univ)
  • Prof Hes­ham Ghaz­al (Alexan­dria univ)
  • Prof Mag­da Badawy (Cairo univ)
  • Prof Madi­ha Abdal­la (Minia univ)
  • Prof Magdy Kamel (Minia univ)
  • Prof M Abdel Aaal El Bagy (Sohag univ)
  • Prof Morad El Alfy (Al Galaa mil­i­tary cen­ter)
  • Prof Nahed Fah­my (Cairo univ)
  • Prof Nay­era Ismaeil (Ain Shams univ)
  • Prof Raguia Atwa (Ain Shams univ)
  • Prof Safaa Shafeek (Ain Shams univ)
  • Prof Sozan Gad (Suez canal univ)
  • Prof Osama Hus­sein (Port said neona­tol­ogy soci­ety)
  • Prof Osama Kasem (Al Galaa mil­i­tary cen­ter)
  • Prof Yehia Mah­moud Basha (Daman­hour teach­ing hosp)
  • Prof Zahraa Ezz El Deen (Cairo univ)