A premature neonate is experiencing severe respiratory distress in the delivery room. Once bag/mask ventilation and oxygen are provided, the condition of the infant deteriorates further. The abdomen appears sunken, low body temperature, cyanotic and nasal flaring. Which action should be strongly considered?


•For a premature infant, respiratory distress syndrome can be largely prevented by the administration of synthetic surfactant through an endotracheal tube. Ventilations are pressure-cycled to control the force of the air delivery.

•The infant is suctioned before surfactant administration. Afterwards, the infant’s airway should not be suctioned for as long as possible to avoid suctioning out the surfactant.

•A possible complication of oxygen therapy in the immature or very ill infant is retinopathy of prematurity or bronchopulmonary dysplasia.

•Pancuronium is a muscle relaxant used during endotracheal intubation and can increase pulmonary blood flow.

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