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Management of Respiratory Distress Syndrome

Authors

Sweet DG, Zimmermann L, Hellström-Westas L, Buonocore G, Bohlin K, Herting E

Target group

Newborn infants at risk of Respiratory Distress Syndrome (RDS) and parents

User group

Healthcare professionals, neonatal units, hospitals, and health services

Statement of standard

Newborn infants at risk of Respiratory Distress Syndrome (RDS) receive appropriate perinatal care including place of delivery, antenatal corticosteroids, guidance around optimal strategies for delivery room stabilisation, and ongoing respiratory support.

Rationale

The goal is to promote optimum survival without complications for newborn infants at risk of Respiratory Distress Syndrome (RDS), whilst minimising potential risks of adverse effects such as pulmonary air leak and bronchopulmonary dysplasia. Many available therapies for the management of RDS involve balancing benefits of treatment with potential risks. With modern practice it is essential that anyone involved in the care of newborn infants is able to comply within their setting to standards of care expected to achieve best outcomes. (1) Treatment of newborn infants with RDS requires access to specialist skills and equipment that are not readily available outside of the neonatal environment. The overall aim is to treat with early surfactant if it is needed, whilst at the same time trying to avoid unnecessary intubation and mechanical ventilation by maximising the use of non-invasive respiratory support and less invasive surfactant administration. (1–3) There are regularly updated European consensus guidelines which form the basis of this standard, and provide more detail where required. (1)

Benefits

Short-term benefits

  • Reduced mortality (3)
  • Reduced pulmonary air leaks (pulmonary interstitial emphysema and pneumothorax) (4)
  • Reduced need for invasive ventilation (1)

Long-term benefits

  • Improved long-term neurodevelopment (5)
  • Reduced healthcare costs (6)
  • Reduced bronchopulmonary dysplasia (BPD) diagnoses (2)

Components of the standard

Component Grading of evidence Indicator of meeting the standard
For parents and family
1. Parents are informed by healthcare professionals about Respiratory Distress Syndrome (RDS), survival rates/morbidity, treatment, and short- and long-term care. (7) A (Low quality)
B (High quality)
Patient information sheet
For healthcare professionals
2. A unit guideline on management of RDS is adhered to by all healthcare professionals. B (High quality) Guideline
3. Training on detection and treatment of RDS in the neonatal intensive care unit (NICU) is attended by all healthcare professionals. (8) A (Low quality)
B (High quality)
Training documentation
4. A unit guideline to determine which pregnant women have to be transferred for care to a perinatal centre is adhered to by all healthcare professionals. (9) (see TEG Birth & transfer) A (Moderate quality) Guideline, audit report
For neonatal unit
5. A unit guideline to ensure a standardised approach to initial stabilisation after birth for newborn infants at risk of RDS is available and regularly updated, including B (High quality) Guideline
  • access to blended oxygen (10)
A (High quality)
  • access to CPAP from birth (2)
A (High quality)
  • access to manual ventilation with devices that control pressures (11)
A (Moderate quality)
  • access to pulse oximetry from birth (12)
A (Low quality)
6. A unit guideline is available and regularly updated including surfactant administration, criteria for intubation, and ventilation strategies with optimal lung protection. (1,13–16) A (High quality)
B (High quality)
Guideline
For hospital
7. Training on management of RDS is ensured. B (High quality) Training documentation
8. Access to radiology, biochemistry, and blood gas analysis is provided throughout the 24 hours. B (High quality) Audit report
9. A unit guideline and evidence of quality improvement initiatives are available within the obstetric service to optimise the use of prenatal corticosteroid therapy. (5) (see TEG Birth & transfer) A (High quality)
B (High quality)
Guideline, audit report
For health service
10. Women at risk for very preterm birth are referred in a timely fashion for expert care during pregnancy and delivery. (17) (see TEG Birth & transfer) A (High quality) Audit report

Where to go

Further development Grading of evidence
For parents and family
N/A
For healthcare professionals
N/A
For neonatal unit
  • Update guidelines using the current European consensus guideline.
B (High quality)
For hospital
N/A
For health service
N/A

Getting started

Initial steps
For parents and family
  • Parents are verbally informed by healthcare professionals about Respiratory Distress Syndrome (RDS), survival rates/morbidity treatment, and short- and long-term care.
For healthcare professionals
  • Attend training on management of RDS.
  • Appraise healthcare professional knowledge in the detection and treatment of RDS and identify gaps in knowledge and training.
For neonatal unit
  • Develop and implement a unit guideline on management of RDS based on the European consensus guidelines.
  • Develop information material on RDS for parents.
  • Develop quality improvement plan for the management of RDS.
For hospital
  • Support healthcare professionals to participate in training on management of RDS.
For health service
N/A

Sources

  1. Sweet DG, Carnielli V, Greisen G, Hallman M, Ozek E, Plavka R, et al. European Consensus Guidelines on the Management of Respiratory Distress Syndrome – 2016 Update. Neonatology. 2017;111(2):107–25.
  2. Rojas-Reyes MX, Morley CJ, Soll R. Prophylactic versus selective use of surfactant in preventing morbidity and mortality in preterm infants. Cochrane Database Syst Rev. 2012 Mar 14;(3):CD000510.
  3. Soll RF. Prophylactic natural surfactant extract for preventing morbidity and mortality in preterm infants. Cochrane Database Syst Rev. 2000;(2):CD000511.
  4. Ardell S, Pfister RH, Soll R. Animal derived surfactant extract versus protein free synthetic surfactant for the prevention and treatment of respiratory distress syndrome. Cochrane Database Syst Rev. 2015 Aug 24;8:CD000144.
  5. Roberts D, Brown J, Medley N, Dalziel SR. Antenatal corticosteroids for accelerating fetal lung maturation for women at risk of preterm birth. Cochrane Database Syst Rev. 2017 21;3:CD004454.
  6. Kann IC, Solevåg AL. Economic and health consequences of non-invasive respiratory support in newborn infants: a difference-in-difference analysis using data from the Norwegian patient registry. BMC Health Serv Res. 2014 Nov 1;14:494.
  7. Davidson J, Aslakson R, Long A, et. al. Guidelines for Family-Centered Care in the Neonatal, Pediatric, and Adult ICU. Crit Care Med. 2017;45(1):103–28.
  8. Cusack J, Fawke J. Neonatal resuscitation: are your trainees performing as you think they are? A retrospective review of a structured resuscitation assessment for neonatal medical trainees over an 8-year period. Arch Dis Child Fetal Neonatal Ed. 2012 Jul;97(4):F246-248.
  9. Boland RA, Davis PG, Dawson JA, Doyle LW. Outcomes of infants born at 22-27 weeks’ gestation in Victoria according to outborn/inborn birth status. Arch Dis Child Fetal Neonatal Ed. 2017 Mar;102(2):F153–61.
  10. Saugstad OD, Aune D, Aguar M, Kapadia V, Finer N, Vento M. Systematic review and meta-analysis of optimal initial fraction of oxygen levels in the delivery room at ≤32 weeks. Acta Paediatr Oslo Nor 1992. 2014 Jul;103(7):744–51.
  11. Guinsburg R, de Almeida MFB, de Castro JS, Gonçalves-Ferri WA, Marques PF, Caldas JPS, et al. T-piece versus self-inflating bag ventilation in preterm neonates at birth. Arch Dis Child Fetal Neonatal Ed. 2017 Jun 29;
  12. Schmölzer GM, Kamlin OCOF, Dawson JA, te Pas AB, Morley CJ, Davis PG. Respiratory monitoring of neonatal resuscitation. Arch Dis Child Fetal Neonatal Ed. 2010 Jul;95(4):F295-303.
  13. Wheeler K, Klingenberg C, McCallion N, Morley CJ, Davis PG. Volume-targeted versus pressure-limited ventilation in the neonate. Cochrane Database Syst Rev. 2010 Nov 10;(11):CD003666.
  14. Bahadue FL, Soll R. Early versus delayed selective surfactant treatment for neonatal respiratory distress syndrome. Cochrane Database Syst Rev. 2012 Nov 14;11:CD001456.
  15. Stevens TP, Harrington EW, Blennow M, Soll RF. Early surfactant administration with brief ventilation vs. selective surfactant and continued mechanical ventilation for preterm infants with or at risk for respiratory distress syndrome. Cochrane Database Syst Rev. 2007 Oct 17;(4):CD003063.
  16. Göpel W, Kribs A, Ziegler A, Laux R, Hoehn T, Wieg C, et al. Avoidance of mechanical ventilation by surfactant treatment of spontaneously breathing preterm infants (AMV): an open-label, randomised, controlled trial. Lancet Lond Engl. 2011 Nov 5;378(9803):1627–34.
  17. Zeitlin J, Papiernik E, Bréart G, EUROPET Group. Regionalization of perinatal care in Europe. Semin Neonatol SN. 2004 Apr;9(2):99–110.

November 2018 / 1st edition / next revision: 2023

Recommended citation

EFCNI, Sweet DG, Zimmermann L et al., European Standards of Care for Newborn Health: Management of Respiratory Distress Syndrome. 2018.

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