A 30-wk, 1.2kg infant develops respiratory distress, grunting and chest retractions within 2 hours of bih. His RR is 70/min. The MOST appropriate next step in management is:
The lungs of preterm infants are especially prone to injury from PPV due to volutrauma. For this reason, if possible, the infant's respiratory effos should be suppoed with nasal continuous positive airway pressure (CPAP) rather than PPV. If PPV is needed, a T-piece resuscitation device should be used to allow precise and consistent regulation of pressure delivery. Resuscitation in the preterm should begin with a blended oxygen concentration of 40% with titration to achieve target oxygen saturations. Ref: Thilo E.H., Rosenberg A.A. (2012). Chapter 2. The Newborn Infant. In W.W. Hay, Jr., M.J. Levin, R.R. Deterding, J.J. Ross, J.M. Sondheimer (Eds), CURRENT Diagnosis & Treatment: Pediatrics, 21e.
Give nasal CPAP
Give surfactant therapy + mechanical ventilation
Mechanical ventilation only
Give warm humidified oxygen through hood mask