CLINICAL AUDIT in NICU regarding use of Surfactant in preterm babies.pptx

It is a clinical trial regarding use of surfactant

1. CLINICAL AUDIT NICU

2. Increase rate of Neonatal Mortality and Morbidity with excessive use of Pulmonary Surfactant Therapy for Neonatal Respiratory Distress Syndrome in the Intensive Care Setting 2

3. agenda Introduction Aims and Objectives Materials and Methods Results Conclusion 3

4. INTRODUCTION Pulmonary surfactant is the treatment of choice for neonatal respiratory distress syndrome,(RDS) as it significantly reduces infant morbidity and mortality. Surfactant is a biologic agent found in the lungs that reduces surface tension within the alveoli , allowing for adequate respiration. Pulmonary conditions such as RDS and Meconium A spiration Syndrome (MAS) are caused by a primary surfactant deficiency and surfactant inactivation, respectively. Extensive clinical trials compare the surfactant products and their optimal usage, but often the practical administration issues are less frequently discussed which are relevant to neonatologists and their support staff at the bedside. In most cases, surfactant is most efficacious when given as early as possible where indicated . This study was conducted to review the use of surfactants in neonates taking practical administration into consideration.

5. AIMS AND OBJECTIVES To evaluate the effect of surfactant administration in the treatment of RDS in relation to mortality and Morbidity in Preterm babies less than 34 weeks of Gestational Age. 5

6. MATERIALS AND METHODS STUDY AREA DEPARTMENT OF NICU, KOTHARI MEDICAL CENTRE DEFINING THE POPULATION CASE- Preterm < 34 to ( 33 6/7) weeks with moderate and severe Respiratory Distress admitted in the NICU in Kothari Medical Centre STUDY DURATION January 2023 to December 2023 (1 year) January 2024 to 31 st May 2024 (5 months) 6

7. MATERIALS AND METHODS (Cont.) INCLUSION AND EXCLUSION CRITERIA Inclusion criteria Preterm < 34 to ( 33 6/7) weeks with moderate and severe Respiratory Distress without CHD admitted in the NICU in Kothari Medical Centre Exclusion criteria Neonates >34 weeks or < 34 weeks with CHD STUDY DESIGN Institution based observational study 7

8. MATERIALS AND METHODS (Cont.) OUTCOME MEASURES PRIMARY Mortality SECONDARY 1. Pneumothorax; 2. Pulmonary Haemorrhage; 3. Air leaks (pneumothorax, pneumomediastinum, pulmonary interstitial emphysema); 4. PPHN; 5. Duration of assisted mechanical ventilation (days); 6. Duration of supplemental oxygen (days); 7. Need for supplemental oxygen at discharge; 8. Chronic lung disease (defined as the need for oxygen therapy at 28 days) 9. Intraventricular haemorrhage (any grade); 8

9. MATERIALS AND METHODS (Cont.) DIAGNOSIS OF RDS Hallmarks of RDS includes 1) Early onset of respiratory distress in an preterm babies 2) Poor lung compliance , hypoxemia 3) Characteristic lung radiography 9

10. RESULTS The data collected in this study is presented in the following tables as seen in the application of Surfactant within 24 Hrs. of delivery 10

11. RESULTS (CONT.) The data collected in this study is presented in the following tables as seen in the application of Surfactant within 24 Hrs. of delivery 11

12. DISCUSSION RDS in preterm baby is a common problem that most paediatricians will encounter in the delivery room and normal newborn nursery As surfactant deficiency is one of the important pathophysiological mechanism responsible of RDS, our study focuses on the efficacy of exogenous surfactant administered in the form of bolus therapy according to the age of presentation and severity of Respiratory distress 12

13. CONCLUSION As per the present literature use of surfactant is well established in the therapy of RDS The study was done with single dose bolus therapy of natural surfactant, administered to all those babies with DOWNES SCORE >7 which implies impending respiratory failure presenting within24 hrs of birth, with the exclusion criteria applied, and studying the efficacy by monitoring the response of ventilator parameters ACTION TAKEN: W e have reduced the use of surfactant in 2024 which has resulted in less complications and better outcomes in neonates. 13

14. Thank you