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European Consensus Guidelines on the Management of Respiratory Distress Syndrome: 2025
David G Sweet1, Virgilio P Carnielli2, Gorm Greisen3
1Regional Neonatal Unit, Royal Maternity Hospital, and Department of Child Health, Queen's University Belfast, Belfast, UK, david.sweet@belfasttrust.hscni.net.
New European guidelines for Respiratory Distress Syndrome (RDS) management emphasize prenatal care, physiological cord clamping, and non-invasive respiratory support. Early surfactant administration and lung-protective ventilation strategies are key for preterm infants.
Area of Science:
- Neonatology
- Perinatal Medicine
- Pediatric Respiratory Care
Background:
- Respiratory Distress Syndrome (RDS) is a common condition in preterm infants.
- Management strategies evolve with emerging evidence, necessitating updated clinical guidelines.
- Optimizing outcomes requires a multidisciplinary approach involving obstetricians and neonatologists.
Purpose of the Study:
- To present the seventh version of the European Guidelines for the Management of RDS.
- To incorporate the latest evidence up to mid-2025 into clinical practice recommendations.
- To provide guidance on prenatal, delivery room, and ongoing respiratory support for infants with RDS.
Main Methods:
- Systematic review of available literature up to mid-2025.
- Consensus development by a panel of European neonatologists and a perinatal obstetrician.
- Focus on evidence-based recommendations for managing RDS in newborns.
Main Results:
- Emphasis on prenatal optimization, including antenatal steroids and risk prediction for preterm delivery.
- Recommendations for delivery room care: physiological cord clamping, thermal management, and non-invasive respiratory support.
- Surfactant prophylaxis and Less Invasive Surfactant Administration (LISA) using videolaryngoscopy are highlighted for extremely preterm infants.
- Nasal ventilation is suggested as a potent non-invasive support mode, with updated thresholds for surfactant treatment and diagnostic use of ultrasound for RDS.
Conclusions:
- Updated guidelines provide a framework for optimizing the care of infants with RDS.
- Integration of non-invasive support, early surfactant, and lung-protective ventilation can improve outcomes.
- Continuous evaluation of evidence is crucial for advancing the management of neonatal respiratory distress.
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