A female infant with an estimated gestational age of 30 weeks was delivered with Apgar scores of 5 and 7 at 1 and 5 minutes, respectively.Over the next hour the infant's respiratory status began to deteriorate, with the infant exhibiting nasal flaring, expiratory grunting, and intercostal retractions.Based on an FIO₂ of 0.60 via oxygen hood ABG results were as follows: pH = 7.26, PaCO₂ = 50 mm Hg, and PaO₂ = 40 mm Hg.A chest x-ray revealed findings consistent with respiratory distress syndrome (RDS): bilateral "ground-glass" appearance and decreased lung volumes.The infant was intubated and placed on mechanical ventilation, and exogenous surfactant was delivered.ABG results after surfactant administration were as follows: pH = 7.36, PaCO₂ = 37 mm Hg, and PaO₂= 78 mm Hg on an FIO₂ of 0.80.What should be done at this time?

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The standard treatment for RDS is surfactant replacement therapy. (A premature infant born at 30 weeks is an automatic candidate for prophylactic surfactant therapy.) Surfactant replacement therapy improves lung compliance by lowering surface tension, allowing alveoli to remain inflated. This improves ABGs and decreases the need for mechanical ventilation and oxygen delivery.

A Female Infant with an Estimated Gestational Age of 30