Give Lungs a Chance

By Danielle Moriates, RN

When babies are born prematurely, they often lack surfactant – a soapy substance produced in the lungs that helps to keep the air sacs open. Without surfactant, these tiny babies fight to breathe, a condition known as infant respiratory distress syndrome. Within the past 50 years, the delivery of artificial surfactant therapy has revolutionized neonatal care, saving many lives that previously would have had no chance at survival. As a neonatal intensive care nurse, I have seen firsthand how much relief and satisfaction it can bring patients when, within seconds of administration, it relieves a baby’s suffering and oxygen saturation soars from deadly levels to a much healthier 90+ percent. Suddenly, everybody in the room can breathe a little easier.

This dramatic effect likely explains why practitioners might be so eager to administer this magical (and expensive) drug.  However, it often times may not actually be necessary.  While it has been a controversial subject, recent studies have proven that treating only those babies who develop signs of respiratory distress syndrome with surfactant as opposed to treating every premature baby that is born not only produces clinical outcomes that are just as good, but perhaps even better.  It has been shown that if every premature infant is first treated using a simple, non-invasive treatment called continuous positive airway pressure (CPAP) and only given surfactant replacement if needed, significantly less surfactant doses would be administered without an increase in morbidity or mortality.

Surfactant is incredibly effective, but exceptionally expensive. It’s not just that surfactant is financially costly, but the treatment comes with some medical risks, which should always be minimized as much as possible. Using Surfactant in place of much cheaper options such as CPAP can hinder the patient’s family financially and lead to a much more difficult care process for the family.  It is our job as care givers to ensure that we consider all treatment options and weigh those alongside of the potential financial outcomes.

It amazes me that, somehow, despite the existence of sound medical research favoring certain treatment plans, there are hospitals all across the country that choose to continue with more costly approaches that offer no additional benefits to the patient. As a newly graduated nurse, I have entered into the medical community eager and enthusiastic to protect and better the lives of my patients and their families, and I can already see how much room there is for improvement in the current system.

As my attending emphasized to everyone as I drew up a dose of surfactant for one of our patients earlier this week, “one drop of that stuff costs more than your lunch today!” When needed to save a precious new life, we should probably not think twice about the cost of a drug; however, when 78% of the doses that are given at birth could have been avoided, nurses need to ensure that they encourage less costly options.

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Danielle Moriates is a NICU nurse at Morgan Stanley Children’s Hospital of New York-Presbyterian. She received her BSN degree from Columbia University this past summer.