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Effect of surfactant replacement therapy in preterm with respiratory distress syndrome in low sources center Al-Zahraa teaching Hospital at Al-Najaf city-Iraq.

Qassim Mohammed Hashim, Ameer Isam Al Aasam, Hala Mohsen Obeid Alwan and Alaa Jumaah Nasrawi*

Background: Every year, 15 million premature babies are born around the world. Prematurity and its complications cause more than a million deaths each year, accounting for approximately a third of all newborn deaths globally. Respiratory failure due to Hyaline Membrane Disease (HMD) is one of the primary causes of preterm infant death and morbidity. Aims of the study: 1) To assess the outcome of surfactant therapy using INSURE method in the management of respiratory distress syndrome. 2) To define the cofounder that may associate with its failure. Methods: This is a cross sectional study was performed in Al Zahraa teaching hospital for maternity and children in a period between January till June 2021. All neonates (gestational age between 28-32 weeks) were enrolled in the study. All of them have been diagnosed as RDS depending on clinical signs (tachypnea, grunting, nasal flaring, and cyanosis, substernal and inter costal retractions) and radiological features (air bronchograms, increasing hypo-aeration, reticulogranular or ground glass opacification). All of them were included in this experiment after receiving SRT using the INSURE technique. The required dose of surfactant was drawn out from its ampoule into a sterile syringe and allowed to warm to room temperature. After endotracheal tube inserted the infant is positioned supine on a flat surface with head turned to one side. Results: A total number of 50 neonates with clinical and radiological signs of RDS were included in the study; 54% of the study was male compared to female 46%. INSURE method was successful in saving the life of 31 out of 50 (62%) of them. The mean birth weights in the failure group were 1180(± 334) grams was significantly lower than the success group 1485 (± 428) grams. This study also showed that the INSURE method was successful in 26 among 36(72%) neonates with gestational age ≥ 30 weeks while succeed in 4 among 14(28%) neonates with gestational age <30 weeks. The severity of RDS was significantly increased in the failure group than in success group (88.8% vs. 12.5%). Tachycardia is most common complication during surfactant replacement therapy (36%), bradycardia (28%) and de saturation (26%). Conclusion: INSURE method is good method in management of respiratory distress syndromethat associated with decreased need for mechanical ventilation & decreased neonatal mortality rate. This study shows that preterm neonates with lower birth weight, lower gestational age, lower Apgar score at 5 minutes, with severe RDS & with prolonged administration have increased risk for INSURE method failure. Tachycardia, bradycardia and de saturation are the main complications during surfactant giving. And enough ICU beds with good nursing care appropriate with number improving outcomes of preterm patient. Every patient was received surfactant echocardiogram must be done to him for risk of PDA.