Respiratory distress syndorme management in newborn eurpeon guidelines

1. EUROPEAN CONSENSUS GUIDELINES ON
THE MANAGEMENT OF RDS
2022 UPDATE

2. BY :
DR.Saleem Akhtar
PGR-PEDIATRICS
SIR GANGARAM HOSPITAL LAHORE

3. PARTICULARS
 1- Prenatal care
 2- Delievery room stabilisation
 3- Respiratory support and stabilisation
 4- supportive care

4. PRENATAL CARE
. Mothers at risk of preterm birth < 28-30 weeks should
be transferred to perinatal centers
. Single course of prenatal coticosteroids to all women
at risk of preterm delievery ;considered potentially
viable pregnancy upto 34 weeks
. Repeat course of steroids may be given in threatened
preterm birth before 32 weeks gestation if first course
was administered atleast 1-2 weeks earlier
.MgSo4 should be given to women with imminent
delivery before 32 weeks

5. DELIEVERY ROOM STABILISATION
 Defer cord clamping upto 60s if clinical
condition allows.
 ( Allows better placental transfusion and
lung aeration >> better heamodynamic
transition)
 When DCC not feasible ; consider umblical
cord milking in infants > 28 weeks gestation.

6. RESPIRATORY SUPPORT
 For spontaneously breathing preterm infants CPAP
should be applied rather than intubation.
 If apnoeic or bradycardiac then ventilating breaths
should be given
 Start CPAP pressure with 6cm H2O and
 Peak insp pressure 20-25cm H2O
 T-piece devices should be used for
resuscitation rather than bag and mask

8.  Oxygen for resuscitation should be controlled using
blender.
 For < 28 weeks gestation Fio2 should be 30%
 For 28-31 weeks. Fio2 21-30%
 For 32 weeks or above Fio2 21%
 Spo2 ---- %or more and Heart rate of
>100/m should be achieved at 5 min.
 Intubation should be reserved if positive pressure
ventilation fails.

9. SURFACTANT INDICATIONS
 1-<30 weeks baby who requires intubation for
stablisation
 2- Worsening babies with RDS when FiO2>30%
 On CPAP pressure ≥6cm H2O
 3- If lung ultrasound suggests surfactant need.
 2 and 3rd dose of surfactant should be given if
needed

10. SURFACTANT PROCEDURES
 LISA. is the preffered method for spontaneously breathing
babies on CPAP
 Laryngeal mask surfactant may b used for mature > 1kg
infants
 IN- SUR-E technique

11. SURFACTANT TYPES AND DOSE
 3 natural (animal drived) preparations
available
 1- Survanta (Beractant 100mg/kg (4ml/kg) )
 2- Curosurf (Poractant alfa 100-200mg/kg (1.25-
2.5ml/kg)
 3-Alveofact (Bovactant 50mg/kg (1.2ml/kg) )
 An initial dose of curosurf 200mg/kg is better
than survanta or alveofact dose.

12. . Rescue surfactant should b given as early as
possible without waiting of
. Radiographic findings and blood gasses.

13. TARGET SPO2
 In preterm babies receiving oxygen spo2 target should
be 90--94%
 Alarm should be set at 89 and 95%
 ROP screening and treating protocols should be
followed

14. NON INVASIVE RESPIRATORY SUPPORT
 CPAP or NIPPV should be started from birth in all
babies at risk of RDS at <30 weeks gestation
 Other methods useful
 HFNC ( heated humidified high flow nasal canula)
 BiPAP ( no advantage over CPAP alone)

15. MECHANICAL VENTILATION
 Mechanical ventilation should be used only when
other methods have failed.
 Lung protective method VTV ( volume targeted) or
HFO ventilation should be preffered.

16.  Inhaled Nitric oxide in preterm babies should be used
limited in documented pulmonary HTN with severe
RDS and stopped if no response
 Caffine (20mg/kg loading. ; 5-10mg/kg maintenace)
should be used to facilitate weaning from MV.
 Short dexamethasone low dose course should be used
prior to extubation of preterm babies remaining on vent
for 1-2 weeks

17. NUTRITION
 70-80 ml/kg/day iv fluids should be started in
humidified incubator and adjusted
 Parenteral nutrition should be started from
birth
 1- Amino acid 1.5-2g/kg/day from day 1
 And quickly build upto 2.5-3.5g/kg/day.
 2- Lipids 1-2g/kg/day build to 4g/kg/day

18. BLOOD TRANSFUSION
. 12mg/dl threshold Hb with severe cardiopulmonary
disease
. 11mg/dl for oxygen depndent
.7mg/dl for stable

19. OTHER SURFACTANT NEED CONDITIONS
 RDS complicated by Congenital pneumonia
 Pulmonary haemorrhage
 ( Surfactant can improve oxygenation following pulmonary haemorrhag
 Severe meconium aspiration syndrome
 Surfactant therapy not recommended in..
 ..Congenital diaphragmetic hernia

20. THANK YOU