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Surfactant Therapy for Premature Newborns In Mumbai
Life-Saving Lung Treatment for Preterm Babies with Respiratory Distress Syndrome
Surfactant therapy is one of the most significant advances in neonatal medicine, dramatically improving survival and outcomes for premature babies with respiratory distress syndrome (RDS). At Shree Hospitals, our neonatology team administers surfactant replacement therapy promptly and expertly to restore lung function, reduce the need for prolonged mechanical ventilation, and protect developing premature lungs.
Premature Baby with RDS? Get Expert Care at Shree Hospitals
Quick facts
Support Types: CPAP, High-Flow Nasal Cannula, Mechanical Ventilation
Conditions Treated:RDS, Prematurity, MAS, Pneumonia, Apnoea
Monitoring: Continuous SpO2, heart rate, blood gas monitoring
Duration: Days to weeks depending on gestation and response
Specialist Team: Neonatologists, respiratory therapists, NICU nurses
Weaning: Gradual step-down from ventilation to CPAP to room air
Key Benefit: Prevents hypoxia and protects developing lung tissue
What is Surfactant Therapy and Why Do Premature Babies Need It ?
Pulmonary surfactant is a complex mixture of lipids and proteins produced by specialised lung cells called type II pneumocytes. It lines the inner surface of the alveoli (air sacs) and reduces surface tension, preventing the alveoli from collapsing at the end of each breath. Without adequate surfactant, breathing requires enormous effort, the alveoli repeatedly collapse, and the lungs cannot oxygenate the blood effectively.
Premature babies are born before their lungs have had time to produce sufficient surfactant. Babies born before 32 weeks gestation are at highest risk of respiratory distress syndrome (RDS) due to surfactant deficiency. RDS causes grunting, nasal flaring, chest wall recession, low oxygen levels, and can rapidly progress to respiratory failure without treatment. Surfactant replacement therapy involves administering exogenous (externally produced) surfactant directly into the lungs via a breathing tube to replace what the premature lung cannot yet produce.
At Shree Hospitals, surfactant therapy is a core component of our neonatal RDS management protocol. We administer natural porcine-derived surfactant (the most clinically effective type) via an endotracheal tube within the first 2 hours of life wherever clinically indicated. Our team uses the INSURE technique (Intubate - Surfactant - Extubate to CPAP) to minimise the time the baby spends on mechanical ventilation following surfactant administration.
Which Babies Are at Risk of RDS and Surfactant Deficiency?
Babies at highest risk of RDS requiring surfactant include:
- Babies born before 32 weeks gestation (highest risk)
- Babies born between 32 and 36 weeks gestation (moderate risk)
- Diabetic mothers - maternal diabetes delays surfactant maturation
- Babies born by elective Caesarean section without labour at less than 38 weeks
- Babies with perinatal asphyxia or hypothermia affecting surfactant function
Early recognition and prompt surfactant therapy dramatically improves outcomes for these babies.
How and When Is Surfactant Administered?
Surfactant is given by instillation directly into the lungs via an endotracheal tube. The timing and method depends on the clinical situation:
- Early rescue surfactant within 2 hours of birth for all babies with confirmed RDS on chest X-ray
- Prophylactic surfactant at birth for extremely premature babies under 27 weeks
- The INSURE technique minimises intubation time by quickly extubating back to CPAP after administration
- Repeat doses are given if the baby continues to show signs of RDS after the first dose
Why Early Surfactant Administration Matters?
Early surfactant therapy produces significantly better outcomes than delayed treatment:
- Reduces mortality from RDS by over 50%
- Reduces the need for high-pressure mechanical ventilation
- Lowers the risk of pneumothorax (air leak from the lung)
- Reduces the incidence of bronchopulmonary dysplasia (BPD)
- Reduces the risk of brain haemorrhage (IVH) associated with respiratory failure
- Every hour of delay in treatment worsens outcomes for the premature baby
Surfactant therapy reduces mortality from respiratory distress syndrome in premature babies by over 50%.
At Shree Hospitals, surfactant replacement therapy is administered by experienced neonatologists within the first 2 hours of life for all eligible premature babies with RDS, following international protocols that have transformed the outlook for premature newborns over the past three decades.
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Our Approach to Surfactant Therapy in Premature Newborns
At Shree Hospitals, we follow an evidence-based surfactant therapy protocol that ensures every eligible premature baby receives the right treatment at the right time. Our neonatology team is experienced in all techniques of surfactant administration and works rapidly to assess, treat, and stabilise babies with RDS in the critical first hours of life.
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Rapid RDS Diagnosis
RDS is diagnosed clinically and confirmed with chest X-ray showing the characteristic ground-glass opacification and air bronchograms. The baby's oxygen requirement, work of breathing, and blood gas results are assessed together to confirm the need for surfactant therapy and the appropriate timing of administration
Early Surfactant Administration
We administer natural porcine surfactant within 2 hours of birth for all eligible babies. The surfactant is instilled directly into the lungs via an endotracheal tube under direct vision in the NICU. Immediate improvement in lung compliance and oxygen requirement is typically seen within minutes of administration.
INSURE Technique to Minimise Ventilation
After surfactant is given, we aim to extubate the baby quickly to nasal CPAP using the INSURE technique. This approach reduces the total duration of mechanical ventilation and the associated risk of lung injury and chronic lung disease (BPD). Repeat doses of surfactant are given if required based on the baby's ongoing oxygen needs and clinical status.
Antenatal Corticosteroid Co-ordination
The most effective approach to surfactant deficiency combines antenatal corticosteroids (steroids given to the mother before premature delivery to accelerate fetal lung maturation) with postnatal surfactant therapy. We liaise closely with the obstetrics team to ensure all mothers at risk of premature delivery have received a complete course of antenatal steroids before delivery wherever possible.
Top Neonatologists in Mumbai
Every specialist at Shree Hospitals is board-certified and has an average of 15+ years of clinical experience in neonatal intensive care, preterm infant management, and neonatal resuscitation.
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Dr. Raghav Arora
Consultant Fetal Medicine Specialist
Neonatal and Newborn Care Services at Shree Hospitals
We offer a full range of specialist neonatal services including surfactant therapy, NICU care, mechanical ventilation, phototherapy for jaundice, total parenteral nutrition, and exchange transfusion, all delivered by expert neonatologists in a dedicated Level III NICU facility.
Step by Step Process of Neonatal Respiratory Support
Step 1 - Clinical Assessment and RDS Diagnosis
On admission to the NICU, the baby's respiratory status is immediately assessed. A chest X-ray is performed and blood gas analysis is completed. Clinical signs of RDS (grunting, recession, high oxygen requirement) combined with the characteristic chest X-ray appearance confirm the diagnosis and the need for surfactant therapy.
Step 2 - Parent Counselling
Before surfactant administration, our neonatologist speaks with the parents to explain the diagnosis of RDS, why surfactant is needed, the procedure involved, and the expected improvement. Written information is provided. Consent is obtained in accordance with clinical urgency.
Step 3 - Intubation
The baby is intubated with an appropriately sized endotracheal tube using careful technique to avoid trauma. Correct tube position is confirmed by chest auscultation, ETCO2 monitoring, and chest X-ray. Sedation is used where appropriate to ensure the baby is comfortable during the procedure.
Step 4 - Surfactant Instillation
Natural porcine surfactant is drawn up in the dose calculated for the baby's weight. It is administered in small aliquots directly into the endotracheal tube, with gentle repositioning between doses to ensure even distribution throughout the lungs. Immediate improvement in lung compliance and oxygen saturation is typically observed within minutes.
Step 5 - Extubation to CPAP (INSURE)
Following surfactant, ventilator settings are reduced rapidly in response to improving lung compliance. Where the INSURE technique is used, the baby is extubated within 30 to 60 minutes of surfactant administration and placed back on nasal CPAP. Blood gases are checked to confirm the baby is maintaining adequate gas exchange on CPAP.
Step 6 - Repeat Dosing and Recovery Monitoring
If the baby remains on a high oxygen requirement or continues to show signs of RDS after the first dose, a repeat dose of surfactant is given at 6 to 12 hours. The baby's oxygen requirement, work of breathing, and blood gas results are monitored closely over the following days as the lung condition evolves and the neonatologist begins weaning respiratory support.
Parent Questions About Surfactant Therapy
What is surfactant and why does my premature baby need it?
Surfactant is a natural substance produced in the lungs that keeps the air sacs (alveoli) open by reducing surface tension. Premature babies are born before their lungs can produce enough surfactant, causing respiratory distress syndrome (RDS) where breathing becomes very difficult and the lungs struggle to oxygenate the blood. Surfactant therapy replaces the missing surfactant, rapidly improving lung function and reducing the need for high-level mechanical ventilation. It is one of the most effective and life-saving treatments in neonatal medicine.
Is surfactant treatment painful for my baby?
The administration of surfactant requires a brief period of intubation (placement of a breathing tube). Our neonatology team uses careful technique and analgesia to make this as comfortable as possible. The treatment itself is not painful and produces rapid benefit. Using the INSURE technique, the breathing tube is removed quickly after surfactant is given, minimising any discomfort associated with intubation.
How many doses of surfactant will my baby need?
Most premature babies with RDS require one dose of surfactant, which produces a significant and sustained improvement in lung function. Approximately 20 to 30% of babies require a second dose if their oxygen requirement remains high or if RDS signs persist after the first dose. Rarely, a third dose is needed. Our neonatologist will reassess your baby's clinical status and blood gases after each dose to determine whether further treatment is required.
Does surfactant therapy prevent long-term lung problems?
Surfactant therapy significantly reduces the risk of severe bronchopulmonary dysplasia (BPD) - the chronic lung disease associated with very preterm birth - by reducing the duration and intensity of mechanical ventilation required. However, extremely premature babies may still develop some degree of chronic lung disease despite surfactant treatment, particularly those born before 28 weeks. Our team follows all premature babies through a structured respiratory follow-up programme after NICU discharge.
Evidence-Based Case Studies by Our Specialists
Would Recommend Us
"Our baby needed a breathing tube and surfactant within an hour of being born. The neonatologists at Shree Hospitals worked so quickly and calmly. Within an hour of the treatment her oxygen levels improved dramatically. She came home six weeks later perfectly healthy."
Parents of Baby Ishaan N. (30-Week RDS - Surfactant INSURE)
"Both our twins needed surfactant as soon as they were born. The team at Shree Hospitals managed them so expertly, giving them the treatment they needed immediately. Both boys are now home and doing brilliantly."
Parents of Twin Boys A. and B. (28-Week RDS - Dual Surfactant Treatment)
"My baby was born at 34 weeks by C-section and developed breathing problems. One dose of surfactant made such a difference - within two days he was off all respiratory support. The care from the neonatology team at Shree Hospitals was wonderful from start to finish."
Mother of Master Rahul D. (34-Week Late Preterm RDS - Surfactant Response)
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