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European Consensus Guidelines on the Management of Neonatal Respiratory Distress Syndrome in Preterm Infants - 2013 Update

Sweet D.G.a · Carnielli V.c · Greisen G.d · Hallman M.e · Ozek E.f · Plavka R.g · Saugstad O.D.h · Simeoni U.i · Speer C.P.j · Vento M.k · Halliday H.L.b
aRegional Neonatal Unit, Royal Maternity Hospital and bDepartment of Child Health, Royal Maternity Hospital, Queen's University Belfast, Belfast, UK; cDepartment of Neonatology, University Hospital Ancona, Università Politecnica delle Marche, Ancona, Italy; dDepartment of Neonatology, Rigshospitalet and University of Copenhagen, Copenhagen, Denmark; eDepartment of Pediatrics, Institute of Clinical Medicine, Oulu University Hospital, University of Oulu, Oulu, Finland; fDepartment of Pediatrics, Marmara University Medical Faculty, Istanbul, Turkey; gDivision of Neonatology, Department of Obstetrics and Gynecology, General Faculty Hospital and 1st Faculty of Medicine, Charles University, Prague, Czech Republic; hDepartment of Pediatric Research, Oslo University Hospital, Rikshospitalet, University of Oslo, Oslo, Norway; iPôle de Néonatologie, Hôpital de la Conception, Assistance Publique Hôpitaux de Marseille, Aix-Marseille Université, Marseille, France; jDepartment of Pediatrics, University Children's Hospital, University of Würzburg, Würzburg, Germany; kNeonatal Research Unit, Health Research Institute La Fe, University and Polytechnic Hospital La Fe, Valencia, Spain Neonatology 2013;103:353-368 (DOI:10.1159/000349928)


Despite recent advances in the perinatal management of neonatal respiratory distress syndrome (RDS), controversies still exist. We report updated recommendations of a European Panel of expert neonatologists who developed consensus guidelines after critical examination of the most up-to-date evidence in 2007 and 2010. This second update of the guidelines is based upon published evidence up to the end of 2012. Strong evidence exists for the role of antenatal steroids in RDS prevention, but it is still not clear if the benefit of repeated courses on respiratory outcomes outweighs the risk of adverse outcomes in the short and long term. Many practices involved in preterm neonatal stabilization at birth are not evidence based, including oxygen administration and positive pressure lung inflation, and they may at times be harmful. Surfactant replacement therapy is crucial in the management of RDS but the best preparation, optimal dose and timing of administration at different gestations is not completely clear. In addition, use of very early continuous positive airway pressure (CPAP) has altered the indications for prophylactic surfactant administration. Respiratory support in the form of mechanical ventilation may be lifesaving but can cause lung injury, and protocols should be directed at avoiding mechanical ventilation where possible by using non-invasive respiratory support such as CPAP. For babies with RDS to have best outcomes, it is essential that they have optimal supportive care, including maintenance of normal body temperature, proper fluid management, good nutritional support, appropriate management of the ductus arteriosus and support of the circulation to maintain adequate tissue perfusion.


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