During surfactant administration, if the infant becomes cyanotic and bradycardic with SpO2 75%, the most appropriate action is to

• A. Administer surfactant more quickly
• B. Stop administering surfactant and administer at a later time
• C. Increase rate of ventilation
• D. Increase FiO2 and slow the rate of surfactant administration

Answer: (D)

When a neonate desaturates and becomes bradycardic during surfactant administration, the priority is to stabilize oxygen delivery while moderating the procedure’s impact on lung mechanics. Increasing FiO2 quickly improves the amount of oxygen reaching the blood, helping to reverse hypoxemia that can drive bradycardia. Slowing the rate of surfactant administration reduces abrupt changes in airway pressures and lung volumes, which can otherwise worsen ventilation-perfusion mismatch and trigger further instability. This combination buys time to reassess airway patency and ventilation, ensure the endotracheal tube is functioning and positioned, and provide additional ventilatory support as needed. If instability persists, follow advanced resuscitation steps.