In the described RDS scenario, what was the PEEP level used?

• A. 4 cmH2O
• B. 6 cmH2O
• C. 8 cmH2O
• D. 12 cmH2O

Answer: (B)

PEEP in neonatal RDS is used to keep alveoli open after they tend to collapse from surfactant deficiency, preserving functional residual capacity and improving oxygenation without causing lung overdistension. A moderate level around 6 cmH2O hit the balance between providing enough airway pressure to recruit and stabilize the lungs and avoiding excessive pressure that could harm fragile neonatal lungs or reduce venous return.

Choosing 4 cmH2O might not be enough to prevent atelectasis and shunt, leading to poorer oxygenation. Going higher to 8 or 12 cmH2O increases the risk of volutrauma, air leaks, and hemodynamic compromise, especially in very small, noncompliant lungs. Therefore, 6 cmH2O is the most appropriate middle ground in this described scenario.