Management

Supportive Measures
1. Incubator care: with frequent monitoring of vital signs
(thermoregulatory, circulatory ,fluid, electrolyte, respiratory) and
arterial blood gases ( SaO2, PaO2 , PaCO2 ,pH )
2. Respiratory support
- Aim: keep PaO2 between 50-80 mmhg (oxygen saturation above 90%)
Method of oxygen delivery
Supportive measures
3. supportive circulation
• IV fluids
• Correct hypotension (Plasma, albumin, dopamine)
4. Support nutrition
If oral feeding cant be tolerated within 4-5 days, advise total
parenteral nutrition.
Specific treatment
Antibiotics
Ampicillin and Gentamycin, as it is difficult to differentiae RDS from congenital pneumonia

Surfactant
Indicated after birth for very low birthweight
Types
Synthetic: Surfaxin
Natural: lung extract of bovine (Survanta), calf (Infasurf) or porcine (Curosurf)

Doses
3-5 ml/kg per dose in endotracheal tube
for 2-4 doses ar 6-12 hours interval
Nasal Continuous Positive Airway
Pressure
- Uses warm humidified oxygen to keep: PaO2 - between 50-70 mmhg = 91-95% and to maintain normal
tissue oxygenation
- If theres significant respiratory distress (retractions and grunting)
- nCPAP at 5-10 cm H2O is indicated
EXPERTS RECOMMENDS
Intubation for prophylactic or early rescue surfactant replacement therapy, followed by extubation back
to nCPAP immediately once the infant is stable , referred as intubate surfactant and extubate (INSURE)
VARIATIONS
- MIST - minimally invasive surfactant therapy
- LISA- less invasive surfactant administration
Combination of early rescue surfactant by INSURE, MIST, LISA with nCPAP is associated with reduced need
for mechanical ventilation, emerging evidence suggests modest benefits in terms of preventing BPD
Mechanical Ventilation
- Indicated for neonates with respiratory failure and persistent apnea
Goal
Improve oxygenation and ventilation without causing injury or oxygen toxicity
Modes of Mechanical ventilation
• synchronized intermittent mechanical ventilation SIMV
• High-frequency ventilation HFV
Most commonly used methods
• High-frequency oscillatory ventilation HFOV
• High-frequency Jet ventilation HFJV
Other Pharmacologic Therapy
• Surfactant replacement therapy
• Dexamethasone
• Inhaled nitric oxide
• Crystalloid
• Dopamine
• Intravenous Hydrocortisone
• Penicillin or Ampicillin with aminoglycoside