RDS-NExT workshop: consensus statements for the use of surfactant in preterm neonates with RDS

Abstract

Objective To provide the best clinical practice guidance for surfactant use in preterm neonates with respiratory distress syndrome (RDS). The RDS-Neonatal Expert Taskforce (RDS-NExT) initiative was intended to add to existing evidence and clinical guidelines, where evidence is lacking, with input from an expert panel. Study design An expert panel of healthcare providers specializing in neonatal intensive care was convened and administered a survey questionnaire, followed by 3 virtual workshops. A modified Delphi method was used to obtain consensus around topics in surfactant use in neonatal RDS. Result Statements focused on establishing RDS diagnosis and indicators for surfactant administration, surfactant administration methods and techniques, and other considerations. After discussion and voting, consensus was achieved on 20 statements. Conclusion These consensus statements provide practical guidance for surfactant administration in preterm neonates with RDS, with a goal to contribute to improving the care of neonates and providing a stimulus for further investigation to bridge existing knowledge gaps.

Gastric Fluid Metabolomics Predicting the Need for Surfactant Replacement Therapy in Very Preterm Infants Results of a Case–Control Study

“…In a study involving extremely preterm infants, surfactant was administered in 99.4% and 61.4% of cases born at 22 and 28 weeks' gestation, respectively [32]. However, the decision to administer surfactant cannot be based on gestational age alone [33]. Regarding "intubation in the DR", although we found this to be the most significant clinical indicator of surfactant use, its predictive value alone was only moderate (AUC 0.69).…”

“…Interestingly, in an artificial intelligence model developed to predict RDS in very low birth weight infants, tracheal intubation at the initial resuscitation ranked last with respect to importance among the various maternal and perinatal-neonatal features evaluated [34]. Still, surfactant is currently recommended in intubated preterm infants, whether intubation was deemed necessary as part of initial stabilization or at any time to promote early extubation [6,33]. Notably, none of the study infants who required intubation immediately after birth were administered prophylactic surfactant in the DR.…”

Safety of Bubble Nasal Intermittent Positive Pressure Ventilation (NIPPV) versus Bubble Nasal Continuous Positive Airway Pressure (NCPAP) in preterm infants with respiratory distress

“…Speci cally, the bubble NIPPV patients presented with worse respiratory distress on average as evidenced by higher mean pretreatment FiO 2 , Silverman Anderson Score and Respiratory Severity Score values in comparison with patients on bubble NCPAP. As noted previously, 11 of the patients in the bubble NIPPV group quali ed for surfactant prior to initiation of bubble NIPPV; of these patients, 9 received surfactant within two hours of NICU admission [15]. Some of these patients had their rst dose of surfactant administered prior to or concurrent with initiation of bubble NIPPV.…”

Respiratory Severity Score and Oxygen Saturation Index during the first two hours of life as predictors for non-invasive respiratory support failure in moderate preterm infants with respiratory distress syndrome

“…(1) Non-invasive respiratory support (NRS), such as Continuous Positive Airway Pressure (CPAP) and surfactant replacement therapy are considered the standard of care for RDS management. (2)(3)(4)(5)(6) Currently, administering NRS immediately after birth and subsequent selective surfactant replacement therapy (SRT) is considered the standard of care. (2)(3)(4)(5)(6) The overall aim is to avoid invasive mechanical ventilation and administer surfactant as early as possible to treat RDS once it is deemed necessary.…”

“…(2)(3)(4)(5)(6) Currently, administering NRS immediately after birth and subsequent selective surfactant replacement therapy (SRT) is considered the standard of care. (2)(3)(4)(5)(6) The overall aim is to avoid invasive mechanical ventilation and administer surfactant as early as possible to treat RDS once it is deemed necessary. Unfortunately, a signi cant proportion of infants develop NRS failure.…”