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
The success of non-invasive ventilation depends on the effectiveness of spontaneous breathing both during transition and on the NICU. Therefore, the focus of the caregiver needs to shift towards... Show moreThe success of non-invasive ventilation depends on the effectiveness of spontaneous breathing both during transition and on the NICU. Therefore, the focus of the caregiver needs to shift towards stimulation instead of trying to take over the spontaneous breathing efforts of the infant with positive pressure ventilation. While different ways for supporting and stimulating breathing effort have been investigated separately, combining these interventions in a bundle of care will potentially increase the success in maintaining effective breathing of the preterm infant, which could improve important clinical outcomes. Show less
When providing oxygen therapy to a preterm infant, targeting SpO2 is essential for avoiding hypoxaemia and/or hyperoxaemia. However, this can be both difficult and challenging for nurses... Show moreWhen providing oxygen therapy to a preterm infant, targeting SpO2 is essential for avoiding hypoxaemia and/or hyperoxaemia. However, this can be both difficult and challenging for nurses working in a neonatal intensive care unit. The general aim of this thesis project was to assess the effect of changes in clinical practice regarding oxygen titration and compliance with respect to targeting SpO2 in preterm infants admitted to our NICU.The stepwise quality improvement project implemented in this thesis project improved compliance with respect to both targeting SpO2 and improving oxygen titration. This led to improved SpO2 distribution and decreases in both hypoxaemia and hyperoxaemia, as well as slight improvements in the handling of ABC events and oxygen titration following ABC. The introduction of training sessions, guidelines, and automated oxygen control increased awareness regarding the consequences of hypoxaemia and hyperoxaemia and led to increased efforts to prevent complications. Show less
Infants born very prematurely (gestational age <32 weeks) are at risk of brain injury and neurodevelopmental problems. Imaging the preterm infant__s brain during the neonatal period, using... Show moreInfants born very prematurely (gestational age <32 weeks) are at risk of brain injury and neurodevelopmental problems. Imaging the preterm infant__s brain during the neonatal period, using cranial ultrasonography (cUS) and magnetic resonance imaging (MRI), is important. Our aim was to study and describe brain findings in very preterm infants using modern, high-quality imaging techniques. Part I reviews brain maturation and injury, and imaging thereof, in very preterm infants. Part II discusses our experience on neonatal cUS (Chapters 2-3) and MRI (Chapter 4), and addresses indications, technical aspects, protocols and safety. Part III gives an overview of findings (incidence and evolution) on frequent, sequential neonatal cUS and term-equivalent MRI (Chapter 5), and their relation with perinatal factors (Chapter 6). Part IV focuses on imaging of white matter (Chapters 7-9), describing both normal maturational phenomena and pathological changes and assessing the accuracy of cUS and MRI for these changes. Part V focuses on imaging of deep grey matter (Chapters 10-12), describing both normal maturational phenomena and pathological changes on cUS and assessing their relation with clinical and MRI findings. Part VI reviews the main findings and conclusions of this thesis, and discusses future perspectives and proposals for further research (Chapter 13). Show less
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
