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When does surfactant begin to form? By how many weeks do the type II calls have more surf than an adult lung?
22 weeks. 38 weeks.
How is fetal lung maturity assessed? When is it performed? When is it not usually preformed before?
Through testing the amniotic fluid. Before 39 weeks but not before 32 weeks
What are the two main strategies to prevent RDS in preterm deliveries?
Antenatal admin of hormones and prophylactic treatment with surf soon after birth
What steroids are recommended?
dex and betamethasone
When are antenatal steroids given?
W/in 24-48 hours before delivery
What does the tx look like for beta and dex? What do antenatal steroids accelerate?
Beta: two 12 mg doses given IM
Dex: 4 doses of 6 mg given IM 12 hours apart. It accelerates the dev of type I and II pneumocytes and stimulates the production of surfactant
What signs would show that surfactant is working?
- reduced FiO2
- reduced WOB
- improved aeration
- improved compliance, resistance, and FRC
- reduced vent support
- improved A-a and OI
What are the different kinds of surfactant and where did they come from? What are the two main animals?
Curosurf: minced pig lung
Infasurf: lavage of newborn calf
Survanta: minced cow lung
Cows and pigs
Which surfactant is most like human and why?
Infasurf because it retains the hydrophobic characteristics
How would you define prophylactic surfactant?
When it is given <15 min of age and before distress.
How would you define rescue surfactant? Who is it given to and when is it given? What is early rescue and what is late rescue?
When it is given to an intubated infant several hours after birth when RDS has been diagnosed. To preterm infants with RDS and w/in the first 12 hours.
Early: 1-2 hours
Late: after 2 hours
How do you determine how much an infant should get?
What type of adapter can be used to give surf w/o interrupting ventilation?
What should be monitored when giving surf?
Proper placement of the ETT, FiO2 and vent settings, reflux into ETT, pt position, chest wall movement, SpO2, VS, VT, BS
What does INSURE stand for?
Intubation, surfactant, and extubation
What do LISA and MIST stand for?
Less invasive surf admin
Minimally invasive surf therapy
What is the gold standard of support during surf?
Intubation, admin of surf, and optimal mechanical ventilation
What are some complications of surf admin?
Plugging of ETT, desat and increased need for O2, transient hypoxemia, bradycardia due to hypoxia, tachycardia due to agitation and reflux, pharyngeal deposition of surf, admin of surf to only one lung, admin of suboptimal dose
What are some physiologic complications?
Apnea, R 2 L shunting resulting in pulmonary hemorrhage, increased shunting through PDA, small increase of risk of ROP, volutrauma risk, alterations in intracranial blood flow
What are some limitations of surfactant administration?
Inability to suction after, positioning problems, really bad for babies who are already bradycardic
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