European Consensus Guidelines on the Management of Respiratory Distress Syndrome: 2022 Update

Abstract

Respiratory distress syndrome (RDS) care pathways evolve slowly as new evidence emerges. We report the sixth version of “European Guidelines for the Management of RDS” by a panel of experienced European neonatologists and an expert perinatal obstetrician based on available literature up to end of 2022. Optimising outcome for babies with RDS includes prediction of risk of preterm delivery, appropriate maternal transfer to a perinatal centre, and appropriate and timely use of antenatal steroids. Evidence-based lung-protective management includes initiation of non-invasive respiratory support from birth, judicious use of oxygen, early surfactant administration, caffeine therapy, and avoidance of intubation and mechanical ventilation where possible. Methods of ongoing non-invasive respiratory support have been further refined and may help reduce chronic lung disease. As technology for delivering mechanical ventilation improves, the risk of causing lung injury should decrease, although minimising time spent on mechanical ventilation by targeted use of postnatal corticosteroids remains essential. The general care of infants with RDS is also reviewed, including emphasis on appropriate cardiovascular support and judicious use of antibiotics as being important determinants of best outcome. We would like to dedicate this guideline to the memory of Professor Henry Halliday who died on November 12<sup>,</sup> 2022.These updated guidelines contain evidence from recent Cochrane reviews and medical literature since 2019. Strength of evidence supporting recommendations has been evaluated using the GRADE system. There are changes to some of the previous recommendations as well as some changes to the strength of evidence supporting recommendations that have not changed. This guideline has been endorsed by the European Society for Paediatric Research (ESPR) and the Union of European Neonatal and Perinatal Societies (UENPS).

Searching for evidence in neonatology

“…ODS has been funded by Chiesi Farmaceutici, The Laerdal Foundation, InfanDx AG. He is co‐author of the European Consensus Guidelines on RDS 25,31 …”

Randomised control trial of oxygen assist module in preterm infants on high-flow nasal cannula support

“…Hence, it is a standard of care in neonatal intensive care unit (NICU) to monitor oxygen saturations (SpO 2 ) using pulse oximetry and to maintain the SpO 2 within a target range (TR). The recommendations for SpO 2 TR in preterm infants under 28 weeks’ gestation is 91%–95% 4–6. The titration of FiO 2 to maintain SpO 2 in TR is hugely dependent on timely manual intervention (M-FiO 2 ) by the bedside staff.…”

Surfactant administration during endotracheal CPAP—Is DD‐Surf comparable to LISA?

“…International European consensus guidelines recommend rescue surfactant administration once a preterm neonate needs Positive end expiratory pressure (PEEP) ≥ 6 cm of H 2 O and FiO 2 > 0.30. 3 Authors have administered surfactant in neonates with respiratory distress requiring FiO 2 ≥ 0.30; however, there is no mention of PEEP which is crucial to establish functional residual capacity before administering surfactant.…”

“…Minimally invasive surfactant administration is emerging as a potential standard of care for administering surfactant in preterm neonates in view of its proven efficacy in reducing bronchopulmonary dysplasia caused due to positive pressure induced lung injury 1 . We read with great interest study done by Mense et al on their novel technique of surfactant administration 2 ; However, we have certain reservations: International European consensus guidelines recommend rescue surfactant administration once a preterm neonate needs Positive end expiratory pressure (PEEP) ≥ 6 cm of H 2 O and FiO 2 > 0.30 3 . Authors have administered surfactant in neonates with respiratory distress requiring FiO 2 ≥ 0.30; however, there is no mention of PEEP which is crucial to establish functional residual capacity before administering surfactant. PEEP used post surfactant administration was variable between 6–10 mbar; which was not compared between DD‐Surf success and failure groups.…”