Audit on the Application of Surfactant in Premature Babies in Assiut University Children Hospital

Abstract Background: To evaluate the use of exogenous natural surfactant for Respiratory Distress Syndrome (RDS) in pre-mature babies, identify areas where European Consensus Guidelines on the Management 2013 Update, modified by The Egyptian Consensus on the Management of Neonatal Respiratory Distress Syndrome in Preterm Infants 2014 are applied to as a reference standard in Assiut University Children Hospital and identify those points to be targeted for improve-ment.
Patients and Methods: A retrospective audit was under-taken over a 12-month period between 1st of January, 2016 to the 31st of December 2016. It included all babies less than 37 weeks gestation with respiratory distress syndrome who received surfactant as a rescue treatment, guided by European Consensus Guidelines on the Management 2013 Update, modified by The Egyptian Consensus on the Management of Neonatal Respiratory Distress Syndrome in Preterm Infants 2014 and admitted to Neonatal Intensive Care Unit of Assiut University Children Hospital during this period. Results: All cases with severe respiratory distress that needed surfactant injection and admitted in Assiut university children hospital from 1st of January to 3 1th of December 2016 were included in the study. The study included 50 patients with severe respiratory distress syndrome.
Conclusion: Surfactant replacement therapy has been available for about 37 years, revolutionizing neonatal respi-ratory care after its introduction in the 1980s. Along with antenatal steroids, surfactants improve survival for preterm babies and they are now recommended routinely as early in the course of Respiratory Distress Syndrome (RDS) as possible. The present study aimed to evaluate the use of surfactant for Respiratory Distress Syndrome (RDS) in premature babies admitted at NICU of Assiut university children hospital during the period from 1st of January to 31st of December 2016 using European Consensus Guidelines on the Management 2013 Update, modified by The Egyptian Consensus on the Manage-ment of Neonatal Respiratory Distress Syndrome in Preterm Infants 2014.
The study included 50 cases with respiratory distress syndrome who received surfactant therapy.
Data of the study showed that treatment regimens for cases of RDS in Assiut University Children Hospital partially followed the reference standard of the study concerning application of surfactant in premature babies.
•Data of the gestational age and weight and sex were recorded in 100% of cases.
•Data concerning clinical evaluation of the studied group were recorded in 100% cases.
•Data concerning obstetric history and prenatal care were fulfilled well but there were no records concerning receiving a course of antibiotics if there is preterm, pre-labor rupture of membranes nor short term tocolytic drugs. Also, the data showed that only 28% of mothers received a course of prenatal steroids if preterm labor was expected.
•Data concerning delivery room stabilization were fulfilled well but there were no records concerning delayed cord clamping and there was no available CPAP at the delivery room nor plastic bag for stabilization of preterm baby with respiratory distress syndrome.
•Data concerning surfactant therapy were fulfilled well but there was no data that any case received prophylactic surfactant therapy neither with nor without INSURE tech-nique.
•Data concerning respiratory support were fulfilled well but no cases received CPAP as a 1st line respiratory support for any spontaneously breathing preterm with RDS at delivery room and no cases received CPAP with early rescue surfactant which is now considered the optimal management for babies with RDS.
•Data concerning supportive care were fulfilled in 100% of cases but no cases received enteral feeding from the 1st day which is strongly recommended with careful fluid balance for early aggressive nutritional support.
•Data concerning prognosis showed that the vast majority of dead cases were below 32 weeks and below 1KG.