Respiratory distress syndrome (RDS) care pathways evolve slowly as new evidence emerges. We report the sixth version of "European Guidelines for the Management of RDS " by a panel of experienced... Show moreRespiratory distress syndrome (RDS) care pathways evolve slowly as new evidence emerges. We report the sixth version of "European Guidelines for the Management of RDS " by a panel of experienced European neonatologists and an expert perinatal obstetrician based on available literature up to end of 2022. Optimising outcome for babies with RDS includes prediction of risk of preterm delivery, appropriate maternal transfer to a perinatal centre, and appropriate and timely use of antenatal steroids. Evidence-based lung-protective management includes initiation of non-invasive respiratory support from birth, judicious use of oxygen, early surfactant administration, caffeine therapy, and avoidance of intubation and mechanical ventilation where possible. Methods of ongoing non-invasive respiratory support have been further refined and may help reduce chronic lung disease. As technology for delivering mechanical ventilation improves, the risk of causing lung injury should decrease, although minimising time spent on mechanical ventilation by targeted use of postnatal corticosteroids remains essential. The general care of infants with RDS is also reviewed, including emphasis on appropriate cardiovascular support and judicious use of antibiotics as being important determinants of best outcome. We would like to dedicate this guideline to the memory of Professor Henry Halliday who died on November 12(,) 2022.These updated guidelines contain evidence from recent Cochrane reviews and medical literature since 2019. Strength of evidence supporting recommendations has been evaluated using the GRADE system. There are changes to some of the previous recommendations as well as some changes to the strength of evidence supporting recommendations that have not changed. This guideline has been endorsed by the European Society for Paediatric Research (ESPR) and the Union of European Neonatal and Perinatal Societies (UENPS). Show less
Sweet, D.G.; Carnielli, V.; Greisen, G.; Hallman, M.; Ozek, E.; Pas, A. te; ... ; Halliday, H.L. 2019
This article presents the case of a 15-year-old boy undergoing laparoscopic appendectomy for phlegmonous appendicitis. During extubation a drop in arterial oxygen saturation (SaO2) occurred due to... Show moreThis article presents the case of a 15-year-old boy undergoing laparoscopic appendectomy for phlegmonous appendicitis. During extubation a drop in arterial oxygen saturation (SaO2) occurred due to the boy biting on the tube. Radiologically, a pulmonary edema was suspected. Ventilation with continuous positive airway pressure (CPAP) and assisted spontaneous breathing (ASB) on the following day led to complete normalization of the patient's condition. The diagnosis of negative pressure pulmonary edema, a complication of acute and chronic obstruction of the upper airways was made. The pathophysiological mechanism of negative pressure pulmonary edema is the development of a pronounced negative (lower than the surrounding pressure) intrapleural pressure during inspiration against the closed glottis. The incidence is between 0.05 and 0.1 % but is probably much higher and the therapy is symptomatic. Show less
Foglia, E.E.; Owen, L.S.; Thio, M.; Ratcliffe, S.J.; Lista, G.; Pas, A.T.; ... ; Kirpalani, H. 2015
Background: Extremely preterm infants require assistance recruiting the lung to establish a functional residual capacity after birth. Sustained inflation (SI) combined with positive end expiratory... Show moreBackground: Extremely preterm infants require assistance recruiting the lung to establish a functional residual capacity after birth. Sustained inflation (SI) combined with positive end expiratory pressure (PEEP) may be a superior method of aerating the lung compared with intermittent positive pressure ventilation (IPPV) with PEEP in extremely preterm infants. The Sustained Aeration of Infant Lungs (SAIL) trial was designed to study this question.Methods/Design: This multisite prospective randomized controlled unblinded trial will recruit 600 infants of 23 to 26 weeks gestational age who require respiratory support at birth. Infants in both arms will be treated with PEEP 5 to 7 cm H2O throughout the resuscitation. The study intervention consists of performing an initial SI (20 cm H2O for 15 seconds) followed by a second SI (25 cm H2O for 15 seconds), and then PEEP with or without IPPV, as needed. The control group will be treated with initial IPPV with PEEP. The primary outcome is the combined endpoint of bronchopulmonary dysplasia or death at 36 weeks post-menstrual age. Show less
Mulder, E.E.M.; Lopriore, E.; Rijken, M.; Walther, F.J.; Pas, A.B. te 2012
At birth, the lungs of preterm infants are most vulnerable. Current recommendations in respiratory support at birth are based on few data and little distinction has been made between term and... Show moreAt birth, the lungs of preterm infants are most vulnerable. Current recommendations in respiratory support at birth are based on few data and little distinction has been made between term and preterm infants. The aim was to gather data that could lead to a better understanding of spontaneous breathing and improvement of the respiratory support of preterm infants at birth. We report that preterm infants at birth use expiratory braking and breath holds to create and defend their functional residual capacity (FRC). It is possible we should mimic these strategies when respiratory support is needed. Applying positive end expiratory pressure (CPAP) in spontaneous breathing preterm infants at birth is feasible and not detrimental, providing early surfactant is given. Experimental studies in this thesis showed that applying positive end expiratory pressure is essential for creating and maintaining FRC during ventilation of preterm infants at birth. Also, an initial sustained inflation of 10-20 seconds at birth creates an immediate FRC and more uniform lung aeration. Combining these strategies has led to a more efficient approach in preterm infants than repeated manual inflations with a self-inflating bag and mask. This thesis contributed to the accumulating evidence for a different approach than currently recommended. Show less
