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Neonatal respiratory distress syndrome

Key sources
The following summarized guidelines for the management of neonatal respiratory distress syndrome are prepared by our editorial team based on guidelines from the European Consensus Group on Respiratory Distress Syndrome (ECG-RDS 2023), the World Health Organization (WHO 2022; 2015), the International Liaison Committee on Resuscitation (ILCOR 2022), the Canadian Paediatric Society (CPS 2021), the American Heart Association (AHA 2020), the Society of Obstetricians and Gynaecologists of Canada (SOGC 2018), the American College of Obstetricians and Gynecologists (ACOG 2017; 2016), and the American Academy of Pediatrics (AAP 2014).
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Guidelines

1.Respiratory support

Oxygen targets: as per ECG-RDS 2023 guidelines, target saturation between 90-94% in preterm infants receiving oxygen beyond stabilization.
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set alarm limits to 89% and 95%.
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  • Noninvasive positive pressure ventilation

  • Invasive ventilation

2.Medical management

Setting of care: transfer pregnant females at high risk of preterm birth < 28-30 weeks of gestation to perinatal centers with experience in the management of respiratory distress syndrome.
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  • Initial stabilization

  • Hemodynamic control

  • Surfactant therapy (indications, RDS)

  • Surfactant therapy (indications, secondary causes)

  • Surfactant therapy (choice of preparation)

  • Surfactant therapy (mode of administration)

  • Surfactant therapy (repeat doses)

  • Inhaled nitric oxide

  • Caffeine

  • Opioids

  • Antibiotic therapy

3.Nonpharmacologic interventions

Nutritional support: initiate parenteral nutrition from birth.
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4.Specific circumstances

Patients with meconium aspiration syndrome, resuscitation: do not perform intrapartum suctioning in infants with meconium-stained amniotic fluid, regardless of whether they are vigorous or not.
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  • Patients with meconium aspiration syndrome (surfactant therapy)

5.Preventative measures

Timing of Cesarean delivery: perform elective pre-labor C-section at or after 39 0/7 weeks of gestation to minimize respiratory morbidity.
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  • Antenatal corticosteroids

  • Prophylactic surfactant therapy