INDIA’S FIRST CASE OF SURFACTANT THERAPY

THE SALSA TECHNIQUE IN A PRE-TERM BABY TO SAVE LUNGS

India

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New Delhi, February 21, 2023:

Surfactant therapy has been the mainstay of treatment for preterm neonates with respiratory distress syndrome. Surfactant therapy is the delivery of a special liquid into the immature lungs of newly born premature babies suffering from breathing difficulty. Delivery of surfactant through endotracheal intubation has been the most commonly used technique. But there are two major problems associated with endotracheal intubation, one that it requires expertise and second that it is associated with complications. In addition, there is also an increased risk of chronic lung disease. A laryngeal mask airway is used to provide positive pressure breaths during resuscitation for newborns who do not cry at birth and are difficult to intubate. Recently, there have been some reports about the use of this device to deliver surfactant globally.

To overcome the above problems, Department of Neonatology, Sir Ganga Ram Hospital for the first time in India tried a technique called SALSA (Surfactant Administration through Laryngeal mask Supraglottic Airway) in a 36 weeks female baby.

This case report has been published in the latest edition of Current Medicine Research & Practice journal.

According to Dr. Satish Saluja, Senior Consultant, Department of Neonatology, Sir Ganga Ram Hospital, “We report the first case from India of administration of surfactant through the laryngeal mask or supraglottic airway (SALSA) which is a minimally invasive method of delivering surfactant. This was also the first case in our institute to receive SALSA“.

Dr. Saluja emphasized that when the Supraglottic Airway Device (SAD) is used to deliver surfactant, there are certain benefits. As the device does not require visualization of the vocal cords, it is relatively fast and easy. The skills required for SALSA are meagre compared to the expertise needed for intubation“.

This is proved by the fact that in our case, the procedure was performed by a resident following short training by experts. In addition, there is less chance of physiological instability during placement, as well as the need for premedication.

During the procedure the baby maintained her heart rate and oxygen saturation. The baby was removed from nCPAP respiratory support after 17 hours and was discharged on the 5th day of life.

Surfactant therapy in preterm neonates with Respiratory Distress Syndrome (RDS) has decreased morbidity and mortality. Surfactant, also called surface-active agent, is a substance such as a detergent that, when added to a liquid, reduces its surface tension, thereby increasing its spreading and wetting properties.

Surfactants used in this manner are typically instilled directly into the trachea. As a premature baby comes out of the womb and the lungs are not fully developed yet, they require administration of surfactant. This is to open the lung alveoli and allow gas exchange for oxygen and help the baby survive.

Up till now delivery of surfactant was done through endotracheal intubation. But this is associated with many problems like respiratory morbidity and bronchopulmonary dysplasia.

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