How should surfactant therapy be administered to a preterm neonate with IRDS?

Surfactant therapy for a preterm neonate with infant respiratory distress syndrome (IRDS) is most effectively administered via endotracheal instillation. This method allows for direct delivery of the surfactant into the lungs, where it can spread through the alveoli to reduce surface tension and improve lung function.

Surfactant is crucial in the treatment of IRDS, as it helps to re-establish alveolar stability, increase lung compliance, and decrease the risk of further respiratory complications. Administering surfactant through an endotracheal tube ensures that the medication reaches the target site in the lungs efficiently, allowing for rapid action and improving oxygenation in the affected neonate.

Other methods, such as nebulizers or dry powder inhalers, are not suitable for this application due to their inability to deliver the surfactant directly to the alveoli in effective concentrations. Nasopharyngeal instillation would also not be appropriate, as it does not provide direct access to the lower respiratory tract where the surfactant is needed. Therefore, endotracheal instillation is the preferred and established method for delivering surfactant in this clinical scenario.