Impact of Updated European Consensus Guidelines on the Management of Neonatal Respiratory Distress Syndrome on Clinical Outcome of Preterm Infants

Abstract

European Consensus Guidelines (ECG) on the management of respiratory distress syndrome (RDS) have been developed and updated twice since 2007 reflecting changes in practice as new evidence emerges. The aim of this study was to evaluate the progress in clinical outcome of babies after the implementation of the updated ECG in 2010. Forty-eight neonates born in 2002-2003 (Group 02/03; n = 15) and in 2012-2013 (Group 12/13; n = 33) at gestational age of 26.2 ± 1.7 weeks were included into this retrospective study. Resuscitation procedures, ventilation support, and postnatal administration of surfactant were assessed. In Group 12/13, compared with Group 02/03, there was a higher rate of maternal corticosteroid prophylactic treatment (33 % vs. 0 %, p < 0.001), more children received primary nasal continuous positive airway pressure (nCPAP) (54.5 % vs. 20 %, p < 0.01) and repeated doses of surfactant (33 % vs. 0 %, p < 0.001), and had a reduced rate of mortality, bronchopulmonary dysplasia, and necrotizing enterocolitis. We conclude that the management of extremely preterm newborns improved considerably over the decade resulting in a significant reduction of mortality and morbidity.

Roles of Lung Ultrasound Score in the Extubation Failure From Mechanical Ventilation Among Premature Infants With Neonatal Respiratory Distress Syndrome

“…Previous studies reported that LUS has good diagnostic accuracy and specificity in comparison with chest X-ray, especially for the quantitative diagnosis of neonatal RDS ( 24 , 25 ). To date, LUS-related studies focused on the predictive values of LUS in need for surfactants and the severity of neonatal RDS ( 15 , 26 ).…”

“…As a non-invasive, dynamic, and real-time imaging technique, ultrasound has been gradually applied in the diagnosis of neonatal pulmonary diseases, such as neonatal RDS, transient tachypnea of new-born, pneumonia, meconium aspiration syndrome, and pneumothorax (20,23). Previous studies reported that LUS has good diagnostic accuracy and specificity in comparison with chest X-ray, especially for the quantitative diagnosis of neonatal RDS (24,25). To date, LUS-related studies focused on the predictive values of LUS in need for surfactants and the severity of neonatal RDS (15,26).…”

Continuous Positive Airway Pressure versus Mechanical Ventilation on the First Day of Life in Very Low-Birth-Weight Infants

“…After these RCTs and recent guidelines on RDS management, the use of CPAP as an initial mode of respiratory support for the management of VLBW with RDS is increased. 9 In our cohort, more than one-third of VLBW infant were managed successfully with CPAP on the fist DOL. Our study, using a large sample size, indicates that the risk of BPD or death is lower with the successful use of CPAP on the first DOL in VLBW infants.…”

“…Recent guidelines also suggest developing protocols directed at avoidance of mechanical ventilation and instead using noninvasive support when possible. 8,9 The objective of the current study was to determine differences in the incidence of BPD or death in very low-birth-weight (VLBW) infants managed successfully with CPAP versus mechanical ventilation on the first day of life (DOL) after widespread use of CPAP as an initial therapy for RDS. We hypothesized that the successful use of CPAP on the first DOL compared with mechanical ventilation would be associated with the reduction in BPD or death in VLBW infants.…”