Exogenous Surfactant Therapy in Premature Infants

ORIGINAL PROPOSAL ABSTRACT:
The leading cause of death for prematurely born infants born in the United States is Respiratory Distress Syndrome (RDS) (Wegman, 1992). Although exogenous surfactant has reduced the death from RDS by up to 87%, the incidence of major sequela such as patent ductus arteriosus (PDA), bronchopulmonary dysplasia, and intraventricular hemorrhage have not been reduced. It has become a nursing responsibility to administer the exogenous surfactant, and care for the premature infant before, during, and after the administration. The purpose of this study is to incorporate findings from the current study and extend knowledge on exogenous surfactant administration (ESA) in premature infants. This will be achieved by systematically examining two types of exogenous surfactant, three methods of administration, the resulting neonatal outcomes, and nursing interventions in response to respiratory and cardiovascular physiologic responses of the neonate. Specific aims are to: (1) Examine the effect of a bovine and protein free exogenous surfactant administered without interruption in ventilation. (2) Examine the effect of a bovine preparation exogenous surfactant administered with interruption in ventilation but based on product guidelines. (3) Examine the five nursing clinical cues for hemodynamically significant PDA following exogenous surfactant administration. (4) Examine the premature infant's outcomes following exogenous surfactant administration. The sample will consist of 48 intubated and mechanically ventilated infants with RDS. Infants will be randomly assigned to one of the three groups. Data from eight physiologic parameters will be selected and recorded simultaneously and continuously for a two hour and thirty minute period prior to and following ESA. Nursing clinical cues, based on neonate physical assessment, regarding the presence of a hemodynamically significant PDA following ESA will be annotated and tracked. Data based on the infants' outcomes following ESA will be collected by concurrent chart reviews, Results from this study will give nurses data on infant outcomes and physiologic responses to two types of surfactant and three methods of administration.