Respiratory support in preterm infants with respiratory distress syndrome

Abstract

Neonatal respiratory distress syndrome (RDS) is most common in premature infants, the smaller the gestational age, the higher the incidence. Continuous positive airway pressure (CPAP) started in the delivery room has been shown in multicentre randomized controlled trials to reduce the need for mechanical ventilation (MV) and surfactant. The European Consensus Guidelines on the Management of Neonatal Respiratory Distress Syndrome in Preterm Infants–2013 Update recommended that CPAP should be started from birth in all babies at risk of RDS and a starting pressure of at least 6 cmH2O (1 cmH2O=0.098 kPa) should be applied. CPAP with early rescue surfactant should be considered the optimal management for babies with RDS. Using CPAP immediately after birth with subsequent selective surfactant administration may be considered as an alternative to routine intubation with prophylactic or early surfactant administration in preterm infants. If endotracheal intubation is needed, early administration of surfactant is preferable. Nasal intermittent positive pressure ventilation may reduce the risk of extubation failure in babies failing on CPAP. Several strategies have been employed specifically to improve the success of noninvasive ventilation and shorten the duration of MV. Caffeine should be used to facilitate weaning from MV and to reduce bronchopulmonary dysplasia. A short tapering course of low- or very low-dose dexamethasone should be considered to facilitate extubation in babies who remain on MV after 1~2 weeks. Very early steroid treatment and treatment with high doses cannot be recommended. Key words: Neonatal respiratory distress syndrome; Continuous positive airway pressure; Premature infant