NCLEX Review Guide: Lung Surfactants in Maternity and Newborn Care

What are Lung Surfactants?

• Surfactants are phospholipid compounds that reduce surface tension in the alveoli, preventing lung collapse during expiration and facilitating easier breathing.
• Natural surfactant production begins around 24-28 weeks gestation but may be insufficient in premature infants, leading to respiratory distress syndrome (RDS).
• Synthetic surfactants are administered to prevent or treat RDS in premature newborns weighing less than 1,250 grams or born before 32 weeks gestation.

Primary Surfactant Preparations

• All surfactants are administered intratracheally only through an endotracheal tube by trained healthcare providers.
• Dosing is calculated based on birth weight, not current weight, and is typically given in divided doses to different lung segments.

Pre-Administration Assessment

1. Verify infant meets criteria: preterm birth, RDS diagnosis, or prophylactic indication
2. Ensure endotracheal tube placement is confirmed via chest X-ray
3. Assess baseline respiratory status including oxygen saturation, ventilator settings
4. Check for contraindications: major congenital anomalies incompatible with life

Administration Technique

• Medication must be warmed to room temperature before administration but never use artificial warming methods.
• Administer slowly over 2-3 minutes with infant in different positions (right side, left side, supine) to ensure even distribution.
• Brief disconnection from mechanical ventilation is required during administration.

Post-Administration Monitoring

• Continuous monitoring of oxygen saturation, heart rate, and blood pressure for at least 2 hours post-administration.
• Rapid improvement in oxygenation may occur, requiring immediate ventilator setting adjustments to prevent oxygen toxicity.
• Monitor for signs of pulmonary hemorrhage, pneumothorax, or bradycardia during and immediately after administration.
• Assess for improvement in chest X-ray findings and decreased oxygen requirements within 6-12 hours.

Common Adverse Effects

• Transient oxygen desaturation during administration is common and usually resolves quickly.
• Bradycardia may occur due to vagal stimulation during endotracheal tube manipulation.
• Reflux of surfactant into the pharynx requires suctioning and possible re-dosing.

Priority Nursing Actions

1. Verify correct infant identification and weight-based dosing
2. Ensure proper equipment and qualified personnel present
3. Monitor vital signs continuously during administration
4. Adjust ventilator settings based on improved compliance
5. Document response and plan for potential additional doses