The management of neonatal respiratory distress syndrome in preterm infants (European Consensus Guidelines—2013 update)

Sakonidou, Susanna; Dhaliwal, Jasbir

doi:10.1136/archdischild-2014-306642

Cited by 41 publications

(26 citation statements)

References 5 publications

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“…Also, we did not differentiate between CPAP and NIPPV that can be used to increase the mean airway pressure above the customary CPAP level. Also, lack of strong evidence concerning maximum CPAP pressure and maximum FiO 2 to predict CPAP failure and indicate intubation is likely another contributor that justifies practice variation [16, 17]. How this variation in unit practices is associated with outcomes requires further investigation.…”

Section: Discussionmentioning

confidence: 99%

Respiratory Management of Extremely Preterm Infants: An International Survey

et al. 2018

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Background: There are significant international variations in chronic lung disease rates among very preterm infants yet there is little data on international variations in respiratory strategies. Objective: To evaluate practice variations in the respiratory management of extremely preterm infants born at < 29 weeks’ gestational age (GA) among 10 neonatal networks participating in the International Network for Evaluating Outcomes (iNeo) of Neonates collaboration. Methods: A web-based survey was sent to the representatives of 390 neonatal intensive care units from Australia/New Zealand, Canada, Finland, Illinois (USA), Israel, Japan, Spain, Sweden, Switzerland, and Tuscany (Italy). Responses were based on practices in 2015. Results: Overall, 321 of the 390 units responded (82%). The majority of units within networks (40–92%) mechanically ventilate infants born at 23–24 weeks’ GA on continuous positive airway pressure (CPAP) with 30–39% oxygen in respiratory distress within 48 h after birth, but the proportion of units that offer mechanical ventilation for infants born at 25–26 weeks’ GA at similar settings varied significantly (20–85% of units within networks). The most common respiratory strategy for infants born at 27–28 weeks’ GA on CPAP with 30–39% oxygen with respiratory distress within 48 h after birth used by units also varied significantly among networks: mechanical ventilation (0–60%), CPAP (3–82%), intubation and surfactant administration with immediate extubation (0–75%), and less invasive surfactant administration (0–68%). Conclusions: There are marked variations but also similarities in respiratory management of extremely preterm infants between networks. Further collaboration and exploration is needed to better understand the association of these variations in practice with pulmonary outcomes.

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Section: Discussionmentioning

confidence: 99%

Respiratory Management of Extremely Preterm Infants: An International Survey

et al. 2018

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“…On the one hand, mechanical ventilation of hyperoxia gives more survival chances for premature infants and seriously ill and respiratory failure patients. On the other hand, the lung that is directly exposed to high oxygen pressure is injured to evoke bronchopulmonary dysplasia, 21 in turn, taking away the lives of patients. Currently, it is generally accepted that ROS plays a pivotal role in hyperoxia-induced lung injury, 22,23 although the mechanisms of hyperoxiainduced lung injury are not completely understood.…”

Section: Discussionmentioning

confidence: 99%

Reactive oxygen and nitrogen species induce cell apoptosis via a mitochondria‐dependent pathway in hyperoxia lung injury

Zou

Fan

et al. 2018

J of Cellular Biochemistry

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Hyperoxia‐induced lung injury limits the application of mechanical ventilation on rescuing the lives of premature infants and seriously ill and respiratory failure patients, and its mechanisms are not completely understood. In this article, we focused on the relationship between hyperoxia‐induced lung injury and reactive oxygen species (ROS), reactive nitrogen species (RNS), mitochondria damage, as well as apoptosis in the pulmonary epithelial II cell line RLE‐6TN. After exposure to hyperoxia, the cell viability was significantly decreased, accompanied by the increase in ROS, nitric oxide (NO), inflammatory cytokines, and cell death. Furthermore, hyperoxia triggered the loss of mitochondrial membrane potential (▵Ψm), thereby promoting cytochrome c to release from mitochondria to cytoplasm. Further studies conclusively showed that the Bax/Bcl‐2 ratio was enlarged to activate the mitochondria‐dependent apoptotic pathway after hyperoxia treatment. Intriguingly, the effects of hyperoxia on the level of ROS, NO and inflammation, mitochondrial damage, as well as cell death were reversed by free radical scavengers N‐acetylcysteine and hemoglobin. In addition, a hyperoxia model of neonatal Sprague‐Dawley (SD) rats presented the obvious characteristics of lung injury, such as a decrease in alveolar numbers, alveolar mass edema, and disorganized pulmonary structure. The effects of hyperoxia on ROS, RNS, inflammatory cytokines, and apoptosis‐related proteins in lung injury tissues of neonatal SD rats were similar to that in RLE‐6TN cells. In conclusion, mitochondria are a primary target of hyperoxia‐induced free radical, whereas ROS and RNS are the key mediators of hyperoxia‐induced cell apoptosis via the mitochondria‐dependent pathway in RLE‐6TN cells.

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“…Updated European guidelines suggest that CPAP should be preferentially started from birth in all babies at risk of RDS (babies usually < 30 weeks gestation) until their clinical status can be assessed. In addition, they recommend suspending prophylactic surfactant to babies at earlier gestational ages and administering early surfactant based on gestational age and FiO 2 requirement (babies < 26 weeks with > 0.3 FiO 2 and > 26 weeks with > 0.4 FiO 2 ) (19) . …”

Section: Discussionmentioning

confidence: 99%

Prophylactic versus Early Rescue Surfactant Treatment in Preterm Infants Born at Less than 30 Weeks Gestation or with Birth Weight Less than or Equal 1,250 Grams

Chun

Sung

et al. 2017

J Korean Med Sci

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Prophylactic surfactant is known to be effective to reduce chronic lung disease in preterm infants compared with rescue surfactant treatment. In Korea, early prophylactic surfactant therapy was introduced in 2011. However, recently, the increased utilization of antenatal steroids and early stabilization through continuous positive airway pressure (CPAP) in the delivery room may have changed the risks and benefits of prophylactic surfactant therapy of infants at high risk of respiratory distress syndrome (RDS). We compared the effects and safety of prophylactic surfactant therapy (within 30 minutes after birth) and early selective surfactant therapy (within 3 hours after birth) in preterm infants born at < 30 weeks gestation or with birth weight ≤ 1,250 g. The clinical data of 193 infants in period 1 (from 2008 to 2010, early selective surfactant therapy group) were collected retrospectively; those of 191 infants in period 2 (from 2012 to 2014, prophylactic surfactant therapy group) were collected prospectively. Compared to period 1, the rate of intubation and surfactant use were significantly increased in period 2. The use of multiple doses of surfactant in period 2 was significantly increased compared with period 1. Despite more invasive and aggressive management in period 2, there was no difference in the duration of mechanical ventilation, the incidence of bronchopulmonary dysplasia (BPD) or death, and the risk of other adverse neonatal outcomes between the 2 groups. In conclusion, the benefit of prophylactic surfactant therapy in infants treated under current practices is no longer clear compared to early selective surfactant therapy.

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The management of neonatal respiratory distress syndrome in preterm infants (European Consensus Guidelines—2013 update)

Cited by 41 publications

References 5 publications

Respiratory Management of Extremely Preterm Infants: An International Survey

Respiratory Management of Extremely Preterm Infants: An International Survey

Reactive oxygen and nitrogen species induce cell apoptosis via a mitochondria‐dependent pathway in hyperoxia lung injury

Prophylactic versus Early Rescue Surfactant Treatment in Preterm Infants Born at Less than 30 Weeks Gestation or with Birth Weight Less than or Equal 1,250 Grams

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