Table of contents

Neonatal respiratory distress syndrome

What's new

Added 2023 ECG-RDS, 2022 WHO, 2022 ILCOR, 2021 CPS, 2020 AHA, 2017 ACOG, and 2015 AAP guidelines for the prevention and management of 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 International Collaboration for Transfusion Medicine Guidelines (ICTMG 2024), the European Consensus Group on Respiratory Distress Syndrome (ECG-RDS 2023), the International Liaison Committee on Resuscitation (ILCOR 2022), the World Health Organization (WHO 2022,2015), the Canadian Paediatric Society (CPS ...
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Respiratory support

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

  • Invasive ventilation

Medical management

Setting of care: as per ECG-RDS 2023 guidelines, 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, respiratory distress syndrome)

  • 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

  • Management of patent ductus arteriosus

Nonpharmacologic interventions

Nutritional support: as per ECG-RDS 2023 guidelines, initiate parenteral nutrition from birth.
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Therapeutic procedures

RBC transfusion: as per ECG-RDS 2023 guidelines, consider using the following thresholds for RBC transfusion in infants:
12 g/dL (hematocrit 36%) in infants with severe cardiorespiratory disease
11 g/dL (hematocrit 30%) in oxygen-dependent infants
7 g/dL (hematocrit 25%) in stable infants beyond 2 weeks of age.

Specific circumstances

Patients with meconium aspiration syndrome, resuscitation: as per ACOG 2017 guidelines, 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)

Preventative measures

Timing of Cesarean delivery: as per SOGC 2018 guidelines, 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