This handout is for neonatal respiratory distress syndrome (rds). Your care team identified this based on: preterm neonate with tachypnea, grunting, retractions, nasal flaring within first hours of life (sweet 2022 pmid 36863329).
Other reasons your team may use this plan: preterm with rising fio₂ requirement to maintain spo₂ 90-94% — surfactant escalation trigger (sweet 2022); cxr with diffuse ground-glass / reticulogranular pattern + air bronchograms — classical rds finding; preterm delivery <34 wks without adequate antenatal corticosteroid course — high pretest rds.
Take these medications exactly as prescribed. Do not stop or change a dose without talking to your provider.
| Medication | Starting dose | How | When | What it does |
|---|---|---|---|---|
| poractant alfa | poractant alfa 200 mg/kg intratracheal via LISA (preferred) or INSURE (preterm <34 wks PMA, FiO₂ > 30% on CPAP, within first 2 h of life ideally) | intratracheal_LISA_or_INSURE | single dose; may repeat 100 mg/kg at 6-12 h if persistent need (FiO₂ > 40%) | Sweet 2022 GRADE strong recommendation for LISA delivery (PMID 36863329); SUPPORT 2010 demonstrated CPAP non-inferiority to early surfactant but rescue dosing improves outcomes (Neofax 2024; Cochrane animal-derived surfactant) |
| beractant | beractant 100 mg/kg (4 mL/kg) intratracheal in 4 aliquots with position changes | intratracheal_endotracheal_tube | single dose; may repeat q6h up to 4 total doses for ongoing need | Bovine surfactant alternative; longer administration time + larger volume per dose vs poractant alfa; Neofax 2024 + Sweet 2022 conditional recommendation |
| caffeine citrate | caffeine citrate 20 mg/kg IV or PO load (=10 mg/kg caffeine base) over 30 min, then 5-10 mg/kg/day maintenance starting 24 h after load | IV or PO | load once, then maintenance daily | CAP trial (Schmidt NEJM 2007 PMID 17989382) — caffeine for AOP improved survival without neurodev disability at 18-21 mo; Sweet 2022 strong recommendation for early caffeine in preterm <30 wks; safer therapeutic window than theophylline (Neofax 2024) |
Plan: Neonatal RDS — surfactant (LISA / INSURE) + caffeine for AOP / extubation support (Sweet 2022 PMID 36863329; SUPPORT NEJM 2010 PMID 20472939; Schmidt CAP NEJM 2007 PMID 17989382)
High-risk follow-up clinic at 3 + 6 + 12 + 24 mo (Bayley III at 18-24 mo). ROP follow-up per ophthalmology. Hearing surveillance. RSV prophylaxis with nirsevimab or palivizumab per AAP / ACIP. Immunization catch-up per ACIP. Lactation continued.
Guideline: Sweet DG et al — European Consensus Guidelines on Management of RDS: 2022 Update (Neonatology 2023 PMID 36863329); SUPPORT NEJM 2010 (PMID 20472939) for early-CPAP vs early-surfactant equivalence; Schmidt CAP NEJM 2007 (PMID 17989382) for caffeine long-term outcomes.