Tidal volume delivery during surfactant administration in the delivery room

Reduced mortality for infants born at less than 30 weeks’ gestation after prophylactic surfactant administration has led many to advocate routine intubation and administration of surfactant in all infants at risk of respiratory distress syndrome. However, surfactant administration is associated with adverse events including bradycardia, changes in cerebral blood flow and endotracheal tube obstruction. The aim of this study was to analyse respiratory function immediately before and after surfactant administration in the delivery room.

We reviewed video recordings of the initial resuscitation in the delivery room of infants born at less than 32 weeks’ gestation between February 2007 and March 2010. Positive pressure ventilation was delivered with either a Neopuff T-piece or self-inflating bag. Respiratory parameters were recorded with a respiratory function monitor (RFM). Each RFM recording was analysed for 30 s before and 2 min after surfactant administration.

Of 230 infants recorded during the study period 16 infants received surfactant in the delivery room. Their mean (standard deviation, SD) gestation and birth weight were 25 (1) weeks and 757 (249) g, respectively. Complete airway obstruction was seen in 4/16 (25%) infants. The median (interquartile range, IQR) duration of this obstruction was 16 (8–27) s. The median (IQR) expired tidal volume before surfactant delivery was 8.0 (5.2–11.2) mL/kg compared to 4.6 (4.1–7.3) mL/kg (p = 0.03) after surfactant administration.

Substantial tidal volume changes occur before, during and after surfactant administration in the delivery room. Complete airway obstruction is common. Monitoring respiratory function during this procedure may help to assess the delivered tidal volume and airway pressures after surfactant treatment.