European Consensus Guidelines on the Management of Respiratory Distress Syndrome - 2016 Update

Abstract

Advances in the management of respiratory distress syndrome (RDS) ensure that clinicians must continue to revise current practice. We report the third update of the European Guidelines for the Management of RDS by a European panel of expert neonatologists including input from an expert perinatal obstetrician based on available literature up to the beginning of 2016. Optimizing the outcome for babies with RDS includes consideration of when to use antenatal steroids, and good obstetric practice includes methods of predicting the risk of preterm delivery and also consideration of whether transfer to a perinatal centre is necessary and safe. Methods for optimal delivery room management have become more evidence based, and protocols for lung protection, including initiation of continuous positive airway pressure and titration of oxygen, should be implemented from soon after birth. Surfactant replacement therapy is a crucial part of the management of RDS, and newer protocols for surfactant administration are aimed at avoiding exposure to mechanical ventilation, and there is more evidence of differences among various surfactants in clinical use. Newer methods of maintaining babies on non-invasive respiratory support have been developed and offer potential for greater comfort and less chronic lung disease. As technology for delivering mechanical ventilation improves, the risk of causing lung injury should decrease although minimizing the time spent on mechanical ventilation using caffeine and if necessary postnatal steroids are also important considerations. Protocols for optimizing the general care of infants with RDS are also essential with good temperature control, careful fluid and nutritional management, maintenance of perfusion and judicious use of antibiotics all being important determinants of best outcome.

Oxygen Saturation Targets in Preterm Infants and Outcomes at 18–24 Months: A Systematic Review

“…This has led to considerable controversy regarding recommendations, with the revised European guidelines recommending a higher-target range (90%-94%) with Grades of Recommendation, Assessment, Development, and Evaluation level of evidence "B." 26 However, adaptation of higher target has been linked to increased ROP 27 and the impact of these guidelines on mortality and long-term visual impairment and NDI needs to be closely observed.…”

“…44 The revised 2016 European guidelines recommend SpO 2 target between 90% to 94% (quality of evidence: moderate; strength of recommendation: weak) and alarm limits at 89% and 95% (quality of evidence: very low; strength of recommendation: weak) for preterm infants receiving oxygen. 26 Individual preterm infants have different mechanisms of susceptibility to injury and resilience to hypoxia and hyperoxia. 45 Factors such as corrected gestational age, 46 growth status, 37 pulmonary hypertension, 38 and ROP 47 influence the risk of hyperoxia and hypoxia.…”

Respiratory Care of the Neonate

“…Also, consensus guidelines on neonates with RD were reviewed [6]. The article describes transition from intra-to extra-uterine life, lists the methods for assessment of neonates with RD, describes the respiratory support in the delivery room, treatment with methylxantines, oxygen and surfactant, and the noninvasive and invasive tools for artificial ventilation.…”

Admission to NICU in air is more likely if nasal High Flow is used for stabilisation in preterm babies compared to face mask CPAP

“…Whilst the latest guidance supports the use of nasal Continuous Positive Airway Pressure (CPAP), (1,2) with evidence of improved outcomes compared with routine invasive respiratory support, (3,4) we recently demonstrated the feasibility of the use of nasal high flow (nHF) in the stabilisation of premature babies (23 to 29+6 weeks gestation) in the delivery room prior to transfer to Neonatal Intensive Care Unit (NICU). (5) Although several large studies have previously demonstrated that nHF is generally as effective as nCPAP for postextubation support, (6)(7)(8) there remains a paucity of literature on the use of nHF in the DR. Our previous study showed that stabilisation on nHF reduced the rate of DR intubation and surfactant administration compared to our prior practice.…”