Pharmacology & Dosage Calculation
A nurse in the Neonatal Intensive Care Unit is caring for premature newborn, is diagnosed with Respiratory…
A nurse in the Neonatal Intensive Care Unit is caring for premature newborn, is diagnosed with Respiratory Distress (RDS) and the doctor ordered administrating surfactant Surfactant should be given by which of the following routes?
Explanation
Core Concept: Neonatal Respiratory Distress Syndrome (RDS) is caused by a deficiency of pulmonary surfactant, leading to high alveolar surface tension and widespread atelectasis. Exogenous surfactant must be administered directly into the trachea (endotracheal route) via an endotracheal tube so it can spread through the bronchial tree and coat the alveoli to stabilize them.
Clinical Presentation:
- Tachypnea, expiratory grunting, nasal flaring, severe retractions, cyanosis shortly after birth.
Diagnosis:
- First-line diagnostic plan: Clinical signs of respiratory distress and pulse oximetry.
- Gold standard test: Chest X-ray showing a diffuse reticulogranular ('ground-glass') appearance with air bronchograms; ABG showing hypoxemia and hypercapnia.
Management:
- Acute management: Endotracheal surfactant replacement therapy, respiratory support with CPAP or mechanical ventilation, and strict thermoregulation.
- Gold standard long-term/definitive management: Prevention via antenatal corticosteroid administration to mothers at risk of preterm delivery (between 24 and 34 weeks gestation) to accelerate fetal lung maturity.