Iowa Neonatology Handbook: Pulmonary

Guidelines for Surfactant Administration (Surfactant Replacement Therapy)

Jonathan M. Klein, MD
Peer Review Status: Internally Peer Reviewed

 I. Indications:

A. The primary use is for the treatment of intubated infants on 40% or more oxygen whose clinical presentation and chest x-ray are consistent with RDS. 

B. Anticipatory or prophylactic administration may be used in infants weighing below 1.35 kg. 

C. Any other indications should be considered experimental until further information is available.

II. Dosing:

The recommended doses are: Exosurf - 5 ml/kg every 12 hours; Survanta- 4 ml/kg every 6-12 hours. Subsequent doses are generally withheld if the infant requires less than 30% oxygen. Surfactant is usually not continued beyond 3 days of life (72 hours). The Pharmacy Department requires that all Surfactant orders be signed or countersigned by the staff neonatologist. The technical details of administration are discussed in the package insert and in the NICU Nursing Protocol on Exosurf and Survanta administration. 

III. Surveillance after administration:

The clinical response is unpredictable. Lung compliance usually improves, sometimes quite rapidly. Blood gases should be monitored frequently, and the ventilator should be adjusted to keep the PCO2 above 40 if possible. Occasionally, gas exchange deteriorates after Surfactant administration, requiring a temporary increase in PIP. In either case, close surveillance of chest wall movement and frequent monitoring of blood gases, especially during the first 3 hours after dosing, will minimize the complications of barotrauma and atelectasis.

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