Neonatal Respiratory Care in Vietnam: Examining Surfactant Use in Resource-Limited Settings

In a high-volume Hanoi NICU, clinicians concentrated surfactant therapy early—often via brief intubation with rapid extubation—administering it to roughly one-third of infants with respiratory distress syndrome (RDS) to match limited invasive-ventilation capacity and vial supply.

Among 895 infants who required respiratory support, 37% of those with RDS received surfactant; nearly half of first-dose administrations used the INSURE method, and most first doses were given within six hours of birth. The study captured surfactant receipt, administration method, and short-term respiratory escalation, revealing a concentrated early-treatment pattern and a clear procedural preference for brief intubation with immediate extubation when feasible.

Non-invasive support dominated bedside management: combined use of nasal CPAP and NIPPV accounted for roughly two-thirds of respiratory support episodes, while invasive ventilation was required in about 23% of infants. Practice therefore favored non-invasive modalities as first-line therapy, with escalation tied to clinical response and available ventilator capacity—decisions shaped by equipment, workforce, and throughput pressures.

Respiratory distress syndrome comprised about 41% of cases requiring respiratory support, making it the single largest driver of surfactant demand and workflow strain. Because RDS cases were predictable yet concentrated, the findings underscore the value of integrating surfactant forecasting into inventory planning and staff allocation in similar referral centers.