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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.

Neonatology
|March 9, 2026
PubMed

Insights

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.

Keywords:
Antenatal corticosteroidsContinuous positive airway pressureEvidence-based practiceMechanical ventilationNon-invasive respiratory supportNutritionOxygen supplementationPatent ductus arteriosusPreterm infantRespiratory distress syndromeSurfactant therapyThermoregulation

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