Neonatal Surfactant Therapy

A premature infant whose type II pneumocytes have not yet produced enough phospholipid-protein surfactant will struggle to keep alveoli open. The resulting atelectasis drives the rapid rise in work of breathing that defines neonatal respiratory distress syndrome (RDS). Exogenous surfactant replaces what the lung cannot make, lowering surface tension, recruiting collapsed units, and letting the same breath move air at lower pressure. The decision to give surfactant hinges on two clinical checkpoints: how much oxygen the infant needs to stay within the target oxygen saturation range, and whether the infant is worsening despite non-invasive support such as continuous positive airway pressure (CPAP). Clinical priority: A premature newborn with grunting, retractions, tachypnoea, or increasing oxygen requirements requires prompt respiratory assessment and appropriate support. The drug is unusual in one important way: it can work within minutes. The danger therefore shifts as soon as it is given. Before the dose, the infant is at risk from collapsed lungs. After the dose, the same oxygen and pressure settings that were keeping the infant alive can cause hyperoxia and lung overdistension. Much of the...