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

NEONATAL CARE NETWORK 2017 (NCN

Recommendations

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)