Practical considerations in the selection and use of pulmonary surfactant therapy for neonatal respiratory distress syndrome in the intensive care setting.

Pulmonary surfactant is the treatment of choice for neonatal respiratory distress syndrome, as it significantly reduces infant morbidity and mortality. Extensive clinical trials compare the surfactant products and their optimal usage, but often the practical administration issues are less frequently discussed. Herein, a panel of respiratory therapists and neonatal nurse practitioners share their experience regarding surfactant usage.

Room air resuscitation versus oxygen resuscitation in the delivery room.

The use of 100% oxygen for delivery room resuscitation is currently the recommended standard of the American Academy of Pediatrics and the Neonatal Resuscitation Program. However, there is mounting evidence from animal and human studies suggesting that resuscitation with room air (RA, 21% oxygen), including positive pressure ventilation with bag and face mask, may be as effective as that with 100% oxygen, and that the use of 100% oxygen may pose a risk of adverse physiologic sequelae. Resuscitation with RA has been demonstrated to result in faster recovery and improved neonatal mortality in comparison to 100% oxygen resuscitation.