INTRAAMNIOTIC SURFACTANT FOR PREVENTION OF NEONATAL RESPIRATORY-DISTRESS SYNDROME (IRDS) - RATIONALE AND PERSONAL-EXPERIENCE

Objective: To evaluate the efficacy of intramniotic instillation of su pplementary surfactant for the prophylaxis of neonatal IRDS in an emer gency obstetric setting. Study design: Supplementary natural surfactan t (SS) was administered intra-amniotically (80 mg in 1 mi) under ultra sound guidance in the proximity of the fetal nostrils and mouth in six pregnant women at 24-32 weeks gestation, with immature amniotic fluid indices of fetal lung maturity, and whose delivery was imminent becau se of severe fetal distress, deteriorating maternal conditions, or ref ractory vaginal bleeding. The administration of SS was preceded by IV aminophylline to the mother (a bolus of 240 mg over 10 min, and a main tenance dose of 0.02-0.1 mg kg(-1) min(-1)) in order to elicit sustain ed fetal breathing movements. Results: The clinical conditions of the six newborn infants were good with no respiratory problems in four cas es, and with mild IRDS in the remaining two, which, however, resolved uneventfully. Conclusions: It is suggested that this prophylactic appr oach has a great potential for becoming a reliable option for the ante natal prevention of IRDS. (C) 1997 Elsevier Science Ireland Ltd.