Premature infants with respiratory distress syndrome (RDS) require stabilization of their lung function, starting with resuscitation. While surfactant remains an important part of the treatment for RDS, increased experience with other methods of respiratory care has led CPQCC to revise its previous recommendations regarding prophylactic surfactant use.
The Improving Initial Lung Function Toolkit provides best practices for initial stabilization of infants with mild RDS using nasal CPAP (NCPAP). In addition, it lays out strategies for addressing moderate RDS with brief intubation for surfactant administration followed by prompt extubation back to NCPAP. While CPQCC no longer advocates across-the-board prophylactic surfactant administration as part of delivery room management and initial stabilization, the toolkit continues to promote the timely and judicious use of exogenous surfactant when indicated.