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Primary surfactant deficiency in premature infants causes respiratory distress syndrome in premature infants. Surfactant pump technique to treat respiratory failure is currently being performed independently at Vinmec Hai Phong and Nha Trang since April 2019.1. Surfactant therapy for neonatal respiratory failure
Indications Surfactant pump is applied in the treatment of respiratory failure in premature infants. In these infants, the enzyme system that catalyzes the synthesis of surfactant by the pneumocytes II is incomplete, while surfactant is essential for lung function in the neonate after birth. Therefore, there is an increased risk of the onset of respiratory failure in neonates.
Factors predisposing to primary surfactant deficiency are more likely to occur in premature infants, boys, second-born twins, cesarean sections, or Caucasian races. Secondary surfactant deficiency often occurs in the following cases: The mother has diabetes, the baby has asphyxia, pneumonia or pulmonary hemorrhage, the child inhales meconium or oxygen poisoning,...
Respiratory distress syndrome in premature babies often treated with the technique of adding surfactan compounds. In the past, medicine often used the technique of endotracheal intubation with surfactant and mechanical ventilation for children. Currently, surfactant pump technique for treatment of neonatal respiratory failure is less invasive and is increasingly widely used. If the child is found to have respiratory failure, surfactant should be used for early treatment.
Specifically, Surfactant therapy should be used for pediatric patients ≤ 26 weeks when FiO2 > 0.30 and for pediatric patients > 26 weeks who need FiO2 > 0.40. A second and sometimes third dose of Surfactant should be administered if there is evidence of progressive respiratory failure. Currently, there are many different methods and techniques for injecting surfactant, which should be considered on a case-by-case basis. Surfactant pump technique in the treatment of respiratory failure in infants has been independently deployed at Vinmec Hai Phong and Nha Trang International General Hospitals since April 2019.
Liệu pháp Surfactant điều trị suy hô hấp được chỉ định ở trẻ sinh non
2. Clinical Benefits of Surfactant Therapy
Improve pulmonary ventilation Increase blood oxygenation Reduce the frequency of air leaks (complications of pneumothorax, alveolar congestion...) Reduce mortality and morbidity in children Reduce the rate of severe disability
3. Indications for use of Surfactant
Inner membrane disease (acute respiratory distress syndrome): Prophylactic treatment, disease treatment, repeat treatment. Treatment of respiratory distress syndrome caused by inhalation of meconium in children Consider treatment in some cases of pulmonary hemorrhage, severe pneumonia.
4. Preparation before performing Surfactant
4.1. Performed by: CKII Doctor Cao Thi Thanh and 02 pediatric residents with > 8 years of experience working in the Resuscitation Department of Hai Phong Children's Hospital.Doctor Cao Thi Thanh has 25 years of working experience in the field of treatment of neonatal pediatric diseases, of which 23 years is in charge of a professional role at the neonatology department of Hai Phong Obstetrics and Gynecology Hospital (a lot of experience in resuscitation). neonatal care in the operating room/delivery room + nursing late premature babies from 34 weeks - 37 weeks), 02 years working at the clinic required Hai Phong Children's Hospital. Currently, Dr. Thanh is working at the Department of Pediatrics - Neonatology of Vinmec International General Hospital.
4.2. Means of performance
Heart rate monitor, SpO2. Ventilator (Model: Carescape R860 - Series: CBRW00234, Manufacturer: GE Healthcare No. - USA) 7-parameter monitor (Model: B40i, Manufacturer: GE Healthcare - Finland) Arterial blood pressure measuring instrument (if any). Blood gas analyzer. Bedside X-ray equipment (if available). 4.3. Pediatric patient
Explain to the patient's family about the technique to be performed. Ensure body temperature, stabilize acid-base, electrolyte, and blood sugar disorders before pumping. The patient was well sedated, endotracheal aspirated before pumping, intubated in the correct position,.
BS CKII Cao Thị Thanh - 25 năm kinh nghiệm điều trị các bệnh lý Nhi sơ sinh
5. Steps to take
5.1. Curosurf Pump Wear a hat, mask, wash hands, wear a shirt, and wear sterile gloves. Cut the catheter to a specified length, about 0.5 - 1 cm shorter than the endotracheal tube. Take the medicine into a cylinder, connect this cylinder to the cannula, inject Curosurf slowly into the probe to push out all the air in the tube. An assistant removed the ventilator from the endotracheal tube so that the doctor could insert the Curosurf catheter into the endotracheal tube, rapidly injecting medicine into the child within 2-3 seconds. Withdraw the tube, proceed to reconnect the endotracheal tube to the ventilator, adjust the pressure just enough to push all the medicine into the lungs. Do not endotracheal intubation within one hour of administering surfactant, unless the child has obvious signs of airway obstruction. Check blood gas 1 - 2 hours after pumping, perform X-ray 2 - 6 hours after pumping. Adjust ventilator, maintain PaO2 > 55mmHg, PCO2 35 - 45mmHg and pH > 7.3. 5.2. Pumping Newfactan and Survanta The steps are similar to those of the Curosurf pump, but these Surfactant drugs have a large volume, so there will be some differences as follows:Newfactan and Alvofact must be mixed according to separate instructions. for each type. Survanta is available as a suspension. Divide the medicine into 3 cylinders. Inject the drug in 3 positions in turn: the patient lies on his or her back, right side, left side. With each position, pump the drug through the endotracheal tube rapidly for 2 - 3 seconds. Then wait for 30 seconds to 2 minutes, or until the patient is stable, then proceed to the next pump. The Surfactant pump technique would be difficult to perform if the overall standard of care was not of high quality. Vinmec has met strict criteria to apply Surfactant Therapy in the treatment of respiratory failure in infants, including a full range of supportive facilities and a team of doctors who are proficient in the following techniques: Intubation, use of ventilators, treatment of respiratory and circulatory emergencies, treatment of pediatric patients with pneumothorax.
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