After surfactant administration in a preterm baby, which of the following outcomes is expected?

NORCERT 8 Mains-2025

Child Health Nursing (Pediatrics)

Medium

Appeared in: NORCERT 8 Mains-2025

Explanation

In preterm infants, Respiratory Distress Syndrome (RDS) is caused by a deficiency of surfactant, a substance that keeps lung alveoli from collapsing.
Administering exogenous surfactant reduces alveolar surface tension, which improves lung compliance (makes the lungs less stiff and easier to inflate).
As lung compliance improves, the infant no longer needs to work as hard to breathe, leading to a noticeable decrease in breathing efforts (e.g., reduced retractions and grunting).
This improvement in lung mechanics is the primary and most immediate therapeutic goal of surfactant replacement therapy.

Option A: The term 'FHR' (Fetal Heart Rate) is incorrect for a neonate. While the neonate's heart rate should stabilize or improve with better oxygenation, a specific 'increase' is not the expected or primary outcome; the main effect is on the respiratory system.
Option C: This is the opposite of the desired therapeutic effect. Increased breathing efforts would indicate treatment failure, a complication, or worsening of the underlying respiratory distress.
Option D: Successful surfactant therapy improves gas exchange efficiency. Therefore, the infant's need for supplemental oxygen should decrease, not increase.

Visual 1: Diagram: Comparison of alveoli in a preterm infant with and without surfactant, showing alveolar collapse (atelectasis) in the deficient state and open, stable alveoli after treatment.
Visual 2: Infographic: Key signs of respiratory distress in a neonate (nasal flaring, grunting, intercostal retractions) and how they resolve after successful surfactant therapy.

Clinical Relevance

Nursing practice connection: This is primarily an exam-oriented knowledge point with limited direct bedside application, so retain Therapeutic Effects of Surfactant in Neonatal Respiratory Distress Syndrome (RDS) as background academic context rather than a clinical decision trigger.
The nurse's primary role is to closely monitor the infant's respiratory status and vital signs before, during, and after surfactant administration to assess for effectiveness and immediate complications.
Rapid improvement in lung compliance is common and requires vigilant monitoring and communication with the respiratory therapist and physician to promptly wean ventilator support and prevent iatrogenic lung injury (volutrauma/barotrauma).
What if? If the infant experiences sudden bradycardia and desaturation during administration, the procedure should be paused. This is often a transient response to airway manipulation or blockage by the liquid, and the infant should be allowed to recover before proceeding.

How to Approach the Question

Identify the core subject of the question: the effect of surfactant therapy in a preterm baby.
Recall the pathophysiology: Preterm babies often have Respiratory Distress Syndrome (RDS) due to a lack of surfactant, which causes stiff lungs and difficulty breathing.
Understand the drug's mechanism of action: Surfactant is administered to replace the deficient substance, reduce surface tension in the alveoli, and make the lungs easier to inflate.
Predict the physiological outcome: If the lungs become less stiff and easier to inflate, the baby will not have to work as hard to breathe.
Evaluate the options based on this prediction: 'Decrease breathing efforts' is the only option that logically follows from the successful action of surfactant. The other options describe a worsening condition or are physiologically incorrect.

Concept Tested & Keywords

Concept Tested: Therapeutic Effects of Surfactant in Neonatal Respiratory Distress Syndrome (RDS)
Stem keywords: surfactant administration, preterm baby, outcomes
Lead-in keywords: which of the following
Negative lead-in flag: false

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