Page 80 - Proceeding of Plenary Abstract of Parallel Symposim

NEONATOLOGI

Less Invasive Surfactant Administration in Preterm Infants with RDS:
Is it Worthy in the future ?

Setya Dewi Lusyati

Abstract
Background With technological advancement and scientific developments, the survival rate of small
premature infants is increasing. Despite of lung morbidity due to lung injuries are predominant. Preterm
infants with gestational age less than 32 weeks have a higher risk for respiratory distress syndrome and most
of them require respiratory support. Today, technology innovations to reduce lung injuries are growing
and leaving a whole new question in surfactant delivery methods. Discussion Surfactant administration
is conventionally administered through intubation and infants still on mechanical ventilation. If surfactant
administration by this method does not carefully make, thereafter the risk of lung injuries will be same, even
can be much higher compared to those infants with carefully mechanical ventilation without any surfactant
replacement. In the last three years, non-invasive surfactant administration methods have been developed with
the aim of reducing intubation rates and shortening of duration mechanical ventilation. The administration
of non-invasive surfactant is given through an endotracheal tube that is inserted directly into trachea with
the help of a Magill tang as deep as around the carina. The infant is maintained on CPAP during surfactant
delivery. Controversies, debates, and studies that support the technique will be presented and discussed in
detail. Likewise provisional recommendations, non-invasive surfactant administration strategies to minimize
side effects, as well as ethical aspect. .
Keywords: surfactant, small preterm infants, lung injuries, respiratory distress syndrome

Nava Ventilation Mode for Preterm Infant

R. Adhi Teguh Perma Iskandar
Department of Child Health, Faculty of Medicine Universitas Indonesia/Dr. Cipto Mangunkusumo General Hospital, Jakarta, Indonesia

Abstract
Background In order to avoid lung injury, synchronization every single baby’s breath with mechanical
positive pressure ventilation is mandatory. Neurally Adjusted Ventilator Assist (NAVA) is new ventilation
mode which detects electrical diaphragmatic activity (Edi) and gives better synchronization compared to
proximal flow sensor dependent ventilation mode. Objective To find out weather invasive or non invasive
NAVA ventilation had better outcome compared to proximal flow sensor dependent ventilation mode
when applied to preterm infant with respiratory distress syndrome (RDS). Results When NAVA applied
to preterm babies RDS, it reduced peak positive inspiratory pressure (PIP) and oxygen requirement
(pP=0.02) . With the Edi peak and Edi min continuous information, NAVA give a trend information about
how much baby’s work of breathing and lung residual capacity so adjustment PIP and positive end expiratory
pressure(PEEP) accordingly to avoid any further lung injury is possible. When used as a sequel mode of

Kongres Nasional Ilmu Kesehatan Anak XVIII 65