Akash Muthiah

East Surrey Hospital
United Kingdom

Abstract Title: Identifying risk factors in term babies who required surfactant therapy on the neonatal unit at a district general hospital

Biography:

Dr Akash Muthiah is a resident doctor based in London, United Kingdom, with a clinical and academic interest in paediatric and neonatal medicine. He is currently working in paediatric emergency medicine and has an interest in neonatal respiratory disorders and quality improvement. This quality improvement audit examined risk factors associated with surfactant use in term infants admitted with respiratory distress to a district general hospital neonatal unit, contributing to the national ATAIN programme.

Research Interest:

Background: Surfactant deficiency is a leading cause of respiratory distress syndrome (RDS) in preterm infants. By 35 weeks’ gestation, fetal surfactant production is usually sufficient to prevent atelectasis and RDS. However, a proportion of term infants still develop significant respiratory distress requiring surfactant therapy. This quality improvement audit aimed to identify risk factors associated with surfactant use in term infants (≥37 weeks’ gestation) admitted to a district general hospital neonatal unit. The project contributed to the national “Avoiding Term Admissions into Neonatal Units” (ATAIN) programme, which seeks to reduce unnecessary neonatal admissions and mother–infant separation.

Methods: A retrospective review of BadgerNet and Eclipse electronic records was performed for term infants who received surfactant therapy between September 2023 and September 2024. Data collected included gestational age, mode of delivery, antenatal risk factors, admission temperature, need for respiratory support, and duration of neonatal unit stay.

Results: Seventeen term infants required surfactant therapy during the study period. Twelve infants (71%) were born between 37–38 weeks’ gestation. Fifteen infants (88%) were delivered by caesarean section, and 14 (82%) were not in active labour at the time of delivery. The mean admission temperature was 36.5°C, with eight infants (47%) hypothermic (<36.5°C). Eight infants (47%) were born to mothers with gestational diabetes. The mean length of neonatal unit stay was eight days.

Conclusion: Caesarean delivery, early-term gestation (37–38 weeks), absence of labour, hypothermia on admission, and maternal gestational diabetes were identified as potential risk factors for surfactant use in term infants. These findings highlight opportunities for preventative strategies and improved perinatal management to reduce respiratory morbidity and avoidable neonatal admissions. The results were presented locally at quality improvement and clinical governance meetings to raise awareness of the clinical, psychological, and financial impact of surfactant therapy in term infants.

Keywords: Surfactant, term infants, respiratory distress, quality improvement