Intraamniotic instillation of surfactant for prevention of neonatal respiratory distress syndrome (RDS): A preliminary report

Supplementary natural surfactant (SS) was administered intra-amniotically (80 mg in 1 ml) under ultrasound guidance in the proximity of the fetal mouth in 5 pregnant women at 28 to 32 wks gestation, with immature amniotic fluid indexes of fetal lung maturity, and whose delivery was imminent because of severe fetal distress as indicated by cardiotocography and Doppler velocimetry of maternal and fetal arteries. The administration of SS was preceded by IV aminophylline to the mother (a bolus of 240 mg over 10 min, and a maintenance dose of 0,02-0,1 mg/kg/min) in order to elicit sustained fetal breathing movements. Following delivery by cesarean section the clinical conditions of four newborn infants were good with no respiratory problems, along with an uneventful clinical course. However, the newborn infant not exposed in utero to aminophylline showed some respiratory problems which required two extra doses of SS after birth. It is suggested that this prophylactic approach has a great potential for becoming a reliable option for the antenatal prevention of RDS.