Indications for surfactant therapy in preterm neonates and two common administration methods.

• A. Indicated for RDS due to surfactant deficiency; Administration: endotracheal instillation (SRT) and less invasive approaches (LISA or INSURE)
• B. Indicated for hyperoxia; Administration: endotracheal instillation and nebulization
• C. Indicated for NEC; IV injection
• D. Indicated for PDA; oral dosing

Answer: (A)

Surfactant therapy is used when preterm infants develop respiratory distress syndrome from surfactant deficiency. Surfactant lowers surface tension in the tiny alveoli, helping them stay open, improving lung compliance, and enhancing oxygenation and gas exchange. Giving surfactant early can reduce the need for invasive ventilation and lower the risk of air leaks and other complications.

Two common ways to administer surfactant are endotracheal instillation and less invasive approaches. Endotracheal instillation involves delivering the surfactant directly through an endotracheal tube, typically after a brief intubation for surfactant replacement therapy. Less invasive methods—such as LISA (Less Invasive Surfactant Administration) or INSURE (Intubate-Surfactant-Extubate)—deliver surfactant while the infant remains on noninvasive support or with only a brief period of intubation, reducing exposure to mechanical ventilation.

Choices like using surfactant for conditions unrelated to surfactant deficiency—hyperoxia, NEC, or PDA—are not indications for surfactant therapy, and routes such as IV or oral dosing are not used for surfactant administration.