A premature infant with respiratory distress syndrome. What interventions are used to reduce risk and improve outcomes?

• A. Antibiotic prophylaxis
• B. Maternal corticosteroids antenatally if preterm; provide surfactant therapy after birth and appropriate respiratory support
• C. Vitamin K
• D. Delayed cord clamping

Answer: (B)

RDS in prematurity stems from surfactant deficiency, which makes the lungs stiff and collapse-prone, leading to poor gas exchange. The best approach to reduce risk and improve outcomes combines prenatal and postnatal strategies that directly enhance lung maturity and function. Giving maternal corticosteroids before an anticipated preterm birth accelerates fetal lung maturation and stimulates surfactant production, lowering the incidence and severity of RDS. After birth, delivering surfactant directly into the lungs replaces the missing surfactant, improves lung compliance, reduces atelectasis, and lowers the need for aggressive ventilation and mortality. This is paired with appropriate respiratory support, typically starting with CPAP and escalating as needed to maintain oxygenation and ventilation. Other measures like vitamin K, delayed cord clamping, or routine antibiotic prophylaxis do not specifically prevent RDS or improve pulmonary outcomes in the same way.