For the first time in India, doctors at Delhi’s Sir Ganga Ram Hospital have carried out SALSA (Surfactant Administration through Laryngeal mask Supraglottic Airway) in a 36 week-old-baby to save her lungs. This case report has also been published in the latest edition of the Current Medicine Research and Practice journal.

Surfactant therapy is the delivery of a special liquid into the immature lungs of newly born premature babies suffering from breathing difficulty.

The hospital said that so far delivery of surfactant through endotracheal intubation has been the most commonly used technique. But there are two major problems associated with endotracheal intubation it requires expertise and second that it is associated with complications.

In addition, there is also an increased risk of chronic lung disease. A laryngeal mask airway is used to apply positive pressure breaths during resuscitation for newborns who do not cry at birth and are difficult to intubate. Recently, there have been some reports about the use of this device to deliver surfactants globally.
Dr Satish Saluja, Senior Consultant, Department of Neonatology, Sir Ganga Ram Hospital, said, “We report the first case from India of administration of surfactant through the laryngeal mask or supraglottic airway (SALSA), which is a minimally invasive method of delivering surfactant. This was also the first case in our institute to receive SALSA.”

Speaking about some of the benefits of the technique, Dr Saluja emphasized the device does not require visualization of the vocal cords, it is relatively fast and easy.

“The skills required for SALSA are meagre compared to the expertise needed for intubation. This is proved by the fact that in our case, the procedure was performed by a resident following short training by experts. In addition, there is less chance of physiological instability during placement, as well as the need for premedication,” he added.

Dr Saluja emphasised that the baby maintained her heart rate and oxygen saturation throughout the procedure. After 17 hours, the baby was taken off nCPAP respiratory support and discharged on the fifth day after birth.

Surfactant therapy in preterm neonates with Respiratory Distress Syndrome (RDS) has decreased morbidity and mortality. Surfactant, also called surface-active agent, is a substance such as a detergent that, when added to a liquid, reduces its surface tension, thereby increasing its spreading and wetting properties.

Surfactants used in this manner are typically instilled directly into the trachea. As a premature baby comes out of the womb and the lungs are not fully developed yet, they require surfactant administration. This is to open the air sacs of the lungs and allow the gas to exchange for oxygen and help the baby survive.

Up till now, delivery of surfactant was done through endotracheal intubation. But this is associated with many problems like respiratory morbidity and bronchopulmonary dysplasia, the doctor added