AARC Clinical Practice Guideline. Surfactant replacement therapy: 2013

Area of Science:

• Neonatal Medicine
• Pulmonology
• Critical Care

Background:

• Neonatal Respiratory Distress Syndrome (RDS) is a significant cause of infant mortality.
• Surfactant deficiency is a primary cause of RDS.
• Evidence-based guidelines are crucial for optimizing surfactant therapy.

Purpose of the Study:

• To update clinical practice guidelines for surfactant replacement therapy.
• To provide evidence-based recommendations for the use of surfactant in neonates.
• To inform clinical decision-making regarding surfactant administration strategies.

Main Methods:

• Systematic literature search of MEDLINE, CINAHL, and Cochrane Library databases (1990-2012).
• Inclusion of randomized controlled trials, systematic reviews, and relevant articles.
• Application of the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) system for recommendations.

Main Results:

• Strong recommendation for surfactant therapy in settings with trained personnel and resuscitation equipment.
• Recommendation for prophylactic surfactant in suspected surfactant deficiency and RDS.
• Strong recommendation for rescue surfactant therapy post-mechanical ventilation for confirmed RDS.
• Multiple surfactant doses recommended over single doses.
• Natural exogenous surfactants preferred over synthetic ones.
• Aerosolized surfactant delivery not recommended at this time.

Conclusions:

• Surfactant replacement therapy is a cornerstone in managing neonatal respiratory distress syndrome.
• Specific administration strategies, including dose frequency and surfactant type, impact clinical outcomes.
• Guidelines emphasize the importance of trained personnel and appropriate clinical settings for safe and effective surfactant administration.