Less invasive surfactant administration combined with nasal high frequency oscillatory ventilation for an extremely low birth weight infant with severe hypercapnia: A case report

BACKGROUND: Respiratory distress syndrome (RDS) is a common neonatal condition in premature infants. Its treatment often requires the use of surfactants. The administration of surfactants has evolved to less invasive surfactant administration (LISA) methods in recent years. Nasal high frequency oscillatory ventilation (nHFOV) is also a good new technology for respiratory support. The use of LISA combined with nHFOV for RDS has not been reported. CASE SUMMARY: A 970 g male infant who was born at 29(+1) weeks of gestational age suffered progressive dyspnea immediately after birth. DIAGNOSIS: According to his clinical symptoms, X-ray, and blood gas analysis results, the extremely low birth weight infant was diagnosed with RDS and deep hypercapnic acidosis. INTERVENTIONS: Less invasive surfactant administration combined with nasal high frequency oscillatory ventilation was utilized in the infant. The mean airway pressure (Paw) was set at 7 cm H2O, amplitude (ΔP) was set at grade 5.5 (level set according to the perception of vibration of the chest wall), frequency was set at 8 Hz, inspiratory time (Ti) was set at 33%, and FiO2 was set at 0.30. OUTCOMES: The patient's pCO2 dropped to 90.9 mm Hg in 2 hours and to 57.8 mm Hg in the following 4.5 hours; the patient was weaned from nHFOV after 12 hours. On day 61, the patient was discharged and free of respiratory symptoms. CONCLUSION: We speculate that less invasive surfactant administration combined with nasal high frequency oscillatory ventilation may be useful in the treatment of RDS with deep hypercapnia to avoid intubation.