European Consensus Guidelines on the Management of Respiratory Distress Syndrome – 2019 Update

Sweet, David G.; Carnielli, Virgilio P.; Greisen, Gorm; Hallman, Mikko; Özek, Eren; Pas, Arjan B. te; Plavka, Richard; Roehr, Charles Christoph; Saugstad, Ola Didrik; Simeoni, Umberto; Speer, Christian P.; Vento, Máximo; Visser, Gerard H.A.; Halliday, Henry L.

doi:10.1159/000499361

Cited by 843 publications

(929 citation statements)

References 191 publications

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“…The recent European guidelines on the management of RDS advocate minimally invasive surfactant therapy as the preferred technique for delivering surfactant to a premature lung for RDS. 20 The main advantages of the present study are adequate sample size, multicenter enrollment, and robust design. However, our trial had some limitations which should be considered in future studies.…”

Section: Discussionmentioning

confidence: 99%

“…However, the relatively BPD incidence in the present study may also be explained by low antenatal steroid coverage (60%), high rate of sepsis (6%), and the genetic predisposition. The recent European guidelines on the management of RDS advocate minimally invasive surfactant therapy as the preferred technique for delivering surfactant to a premature lung for RDS …”

Section: Discussionmentioning

confidence: 99%

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Surfactant therapy in premature babies: SurE or InSurE

Jena

Bains

Pandita

et al. 2019

Pediatric Pulmonology

104

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Background: Preterm infants with respiratory distress syndrome (RDS) requiring surfactant therapy have been traditionally receiving surfactant by intubation surfactant and extubation technique (InSurE), which comprises of tracheal intubation, surfactant administration, and extubation. However, more recently noninvasive methods like least invasive surfactant therapy or minimally invasive surfactant therapy have been reported to be successful. These methods, avoid intubation thus minimize airway trauma and avoid barotrauma. The primary aim of this randomized trial was to compare the need for mechanical ventilation (MV) between the administration of surfactant via a thin catheter during spontaneous breathing and the InSurE technique. Methods: Preterm infant's ≤34 weeks with RDS requiring continuous positive airway pressure (CPAP) within 6 hours of life were prospectively randomized to receive early surfactant either by SurE (surfactant without endotracheal tube intubation) or InSurE technique. The need for MV within the first 72 hours and other related outcomes were analyzed between the two groups. Results: One hundred seventy‐five infants in each group were analyzed. The need for MV in the first 72 hours of life was significantly lower in the SurE group compared to the InSurE group (19% vs 40%, P < .01). Similarly, duration of oxygen therapy and hospital stay were significantly shorter in the SurE group. Furthermore, bronchopulmonary dysplasia (BPD) rate was significantly lower among the infants administered surfactant by the SurE technique. Conclusion: In preterm neonates with RDS who are stabilized on CPAP, the SurE technique for surfactant delivery results in the reduced need for MV and also may decrease the rate of BPD in some vulnerable subpopulations.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Surfactant therapy in premature babies: SurE or InSurE

Jena

Bains

Pandita

et al. 2019

Pediatric Pulmonology

104

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“…The latest guidelines from the American and the European neonatal societies recommend minimal instrumentation of the airways of premature babies with the prophylactic use of noninvasive respiratory support (NIV) and nCPAP as the standard of care . In large multicenter trials, nCPAP treatment alone achieved outcomes that were not inferior to those obtained by endotracheal instillation of surfactant .…”

Section: Introductionmentioning

confidence: 99%

Lung deposition of nebulized surfactant in newborn piglets: Nasal CPAP vs Nasal IPPV

Nord

Linnér

Salomone

et al. 2019

Pediatric Pulmonology

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Background Nasal continuous positive airway pressure support (nCPAP) is the standard of care for prematurely born infants at risk of neonatal respiratory distress syndrome (nRDS). However, nasal intermittent positive pressure ventilation (NIPPV) may be an alternative to nCPAP in babies requiring surfactant, and in conjunction with surfactant nebulization, it could theoretically reduce the need for invasive mechanical ventilation. We compared lung deposition of nebulized poractant in newborn piglets supported by nCPAP or NIPPV. Methods Twenty‐five sedated newborn piglets (1.2‐2.2 kg) received either nCPAP (3 cmH2O, n = 12) or NIPPV (3 cmH2O positive end expiratory pressure+3 cmH2O inspiratory pressure, n = 13) via custom‐made nasal prongs (FiO2 0.4, Servo‐i ventilator). Piglets received 200 mg kg−1 of technetium‐99m‐surfactant mixture continuously nebulized with a customized eFlow‐Neos investigational vibrating‐membrane nebulizer system. Blood gases were taken immediately before, during, and after nebulization. The deposition was estimated by gamma scintigraphy. Results Mean surfactant deposition in the lungs was 15.9 ± 11.9% [8.3, 23.5] (mean ± SD [95% CI]) in the nCPAP group and 21.6 ± 10% [15.6, 27.6] in the NIPPV group (P = .20). Respiratory rates were similar in both groups. Minute volume was 489 ± 203 [360, 617] in the nCPAP group and 780 ± 239 [636, 924] mL kg−1 min−1 in the NIPPV group (P = .009). Blood gases were comparable in both groups. Conclusion Irrespective of the noninvasive ventilatory support mode used, relatively high lung deposition rates of surfactant were achieved with nebulization. The amounts of deposited surfactant might suffice to elicit a pulmonary function improvement in the context of nRDS.

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“…In view of these benefits, early caffeine has become an important part of newborn respiratory care to minimise mechanical ventilation . Early caffeine is increasingly being used as an adjunctive therapy to other interventions, like early continuous positive airway pressure in the management of respiratory distress syndrome in order to reduce lung injury in preterm infants .…”

Section: Introductionmentioning

confidence: 99%

Variations in preterm stabilisation practices and caffeine therapy between two European tertiary level neonatal units

et al. 2019

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Aim To investigate interinstitutional differences in preterm infant stabilisation between two European tertiary neonatal centres with particular focus on intubation timing, surfactant administration, caffeine therapy and neonatal morbidity and mortality. Methods Retrospective (2012‐2014) study of very low birth weight (VLBW) preterm infants admitted to John Radcliffe Hospital (UK centre) and Charité Medical Centre (German centre). Timing of intubation, surfactant and caffeine administration and respiratory outcomes were examined. Results Gestational age, birth weight and five‐minute Apgar scores of VLBW infants from the UK centre (n = 86) were comparable to those from the German centre (n = 96). Significant differences in antenatal steroid therapy, intubation timing and surfactant therapy were noted. Timing of caffeine initiation differed significantly between centres (median 0 [0‐2.5] UK vs. 2 [1.5‐4] days German centre); however, caffeine was discontinued at a similar corrected gestational age of 34.7 weeks. Mechanical ventilation was significantly longer at the UK centre, but there was no difference in bronchopulmonary dysplasia (BPD) (44% UK vs. 36% German centre) or mortality (15% UK vs. 13% German centre). Conclusion Timing of primary intubation and caffeine therapy differed significantly between centres. However, earlier intubation and caffeine administration in the UK centre were not associated with a changed incidence of BPD.

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European Consensus Guidelines on the Management of Respiratory Distress Syndrome – 2019 Update

Cited by 843 publications

References 191 publications

Surfactant therapy in premature babies: SurE or InSurE

Surfactant therapy in premature babies: SurE or InSurE

Lung deposition of nebulized surfactant in newborn piglets: Nasal CPAP vs Nasal IPPV

Variations in preterm stabilisation practices and caffeine therapy between two European tertiary level neonatal units

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