What is the most appropriate recommendation when a 28-week-old gestational age infant shows bilateral haziness on a chest radiograph?

• A. Decrease mandatory rate
• B. Increase PIP
• C. Increase FIO2
• D. Administer Exosurf®

Answer: (D)

A 28-week-old gestational age infant showing bilateral haziness on a chest radiograph is likely exhibiting signs of Respiratory Distress Syndrome (RDS), which is common in preterm infants due to surfactant deficiency. Administration of Exosurf®, which is a synthetic surfactant, helps to improve lung function by reducing the surface tension in the alveoli, thereby improving gas exchange and decreasing the risk of atelectasis.

The recommendation to administer Exosurf® is appropriate in this context because it directly addresses the underlying issue of surfactant deficiency, which is indicated by the haziness seen on the radiograph. By providing surfactant replacement therapy, the infant's lung compliance can be improved, promoting better oxygenation and facilitating effective ventilation.

Other options, while potentially relevant in certain contexts, do not directly resolve the surfactant deficiency or the immediate need for respiratory support in this setting. Adjustments to mandatory rate, peak inspiratory pressure, or increasing FIO2 may manage symptoms or support respiration, but they do not address the primary issue of insufficient surfactant in this preterm infant as effectively as administering Exosurf®.