Administration of Surfactant in the Delivery Room

Rasan Suresh, Anitha Ananthan, Ruchi Nanavati

Abstract

Background and Aim: Surfactant replacement has been established as an effective and safe therapy for respiratory distress syndrome. Administering surfactant within 1 to 2 hours of birth, called early-rescue surfactant therapy, has been shown to be more efficient in reducing morbidity and mortality than late-rescue surfactant therapy. In our hospital, the delivery room (DR) and the NICU are in different buildings, making it difficult to shift the neonate within 2 hours of birth to the NICU for surfactant administration. Hence, we planned this quality improvement (QI) study to enable the administration of early rescue surfactant therapy in the DR itself.

Materials and Methods: This QI study was planned according to the Point of Care Quality Improvement module, using the fishbone analysis model, to identify various contributing factors. Four Plan-Do-Study-Act (PDSA) cycles, each of 2 weeks duration, was followed by a sustenance period of 8 weeks. Data collected were analyzed using run charts.

Results: Before the initiation of this QI study, surfactant administration in the DR was not practiced in our hospital. After the initiation of this QI, surfactant administration in the DR was successful in 55% of the eligible neonates in the first PDSA cycle, in 25% neonates in the second PDSA cycle, 66% neonates in third PDSA cycle, and 100% neonates in the fourth PDSA cycle. In the sustenance period, 90% of the eligible neonates received surfactant in the DR.

Conclusion: A simple QI approach, with proper utilization of the available manpower and other resources, resulted in successful DR surfactant administration in the DR in eligible preterm neonates.