European Consensus Guidelines on the Management of Neonatal Respiratory Distress Syndrome in Preterm Infants – 2010 UpdateSweet D.G.a · Carnielli V.b · Greisen G.c · Hallman M.d · Ozek E.e · Plavka R.f · Saugstad O.D.g · Simeoni U.h · Speer C.P.i · Halliday H.L.j
aRegional Neonatal Unit, Royal Maternity Hospital, Belfast, UK; bDipartimento di Neonatologia, Ospedale Universitario di Ancona, Università Politecnica delle Marche, Ancona, Italy; cDepartment of Neonatology, Rigshospitalet and University of Copenhagen, Copenhagen, Denmark; dDepartment of Pediatrics, Institute of Clinical Medicine, Oulu University Hospital, University of Oulu, Oulu, Finland; eDepartment of Pediatrics, Marmara University Medical Faculty, Istanbul, Turkey; fDivision of Neonatology, Department of Obstetrics and Gynecology, General Faculty Hospital and 1st Faculty of Medicine, Charles University, Prague, Czech Republic; gDepartment of Pediatric Research, Rikshospitalet Medical Center, Faculty of Medicine, University of Oslo, Oslo, Norway; hService de Néonatologie, Hôpital de la Conception, Assistance Publique – Hopitaux de Marseille, Marseille, France; iDepartment of Pediatrics, University Children’s Hospital, Würzburg, Germany; jDepartment of Child Health, Queen’s University Belfast and Royal Maternity Hospital, Belfast, UK
Keywords: Antenatal steroidsContinuous positive airway pressureEvidence-based practiceMechanical ventilationOxygen supplementationPatent ductus arteriosusRespiratory distress syndromeSurfactant therapyThermoregulation
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Despite recent advances in the perinatal management of neonatal respiratory distress syndrome (RDS), controversies still exist. We report the updated recommendations of a European panel of expert neonatologists who had developed consensus guidelines after critical examination of the most up-to-date evidence in 2007. These updated guidelines are based upon published evidence up to the end of 2009. Strong evidence exists for the role of a single course of antenatal steroids in RDS prevention, but the potential benefit and long-term safety of repeated courses are unclear. Many practices involved in preterm neonatal stabilisation 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 always clear. Respiratory support in the form of mechanical ventilation may also be lifesaving, but can cause lung injury, and protocols should be directed at avoiding mechanical ventilation where possible by using nasal continuous positive airways pressure or nasal ventilation. For babies with RDS to have best outcomes, it is essential that they have optimal supportive care, including maintenance of a normal body temperature, proper fluid management, good nutritional support, management of the ductus arteriosus and support of the circulation to maintain adequate tissue perfusion.
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