Management Of Respiratory Distress Syndrome Research Articles

Characterization of dipyridamole as a novel ferroptosis inhibitor and its therapeutic potential in acute respiratory distress syndrome management

Characterization of dipyridamole as a novel ferroptosis inhibitor and its therapeutic potential in acute respiratory distress syndrome management

The Analysis Study of Diagnosis and Management of Respiratory Distress Syndrome in Neonatus: A Comprehensive Systematic Review

The Analysis Study of Diagnosis and Management of Respiratory Distress Syndrome in Neonatus: A Comprehensive Systematic Review

Comparison of the effect of surfactant administration during nasal continuous positive airway pressure with that of nasal continuous positive airway pressure alone on respiratory distress syndrome

Background. The American Academy of Pediatrics states that prophylactic surfactant is no longer advised when continuous positive airway pressure (CPAP) is frequently used to stabilize preterm newborns and where the rate of prenatal corticosteroid is high. On the other hand, the European Consensus Guidelines on the Management of Respiratory Distress Syndrome (RDS) urge giving prophylactic surfactants to infants with RDS as early as possible. In this study, we aim to investigate the appropriate guidelines to be adopted in our neonatal intensive care unit about selective or elective INSURE (intubation-surfactant-extubation) method. Materials and methods. This is a clinical trial in which a total number of 120 neonate patients were diagnosed with RDS and had gestational age of 30–34 weeks. Two neonatal intensive care units have been included in the study: group A (n = 87) was treated with CPAP plus INSURE and group B (n = 33) was treated with CPAP only. The primary outcome we searched for is the fate of the patients. The secondary outcomes were length of hospital stay, CPAP management, oxygen therapy, and RDS complications. Results. Group B show a shorter length of hospital stay and CPAP treatment; however, this difference was not statistically significant. On the other hand, oxygen therapy duration was significantly shorter in group B than in group A. Both groups show very close rates of RDS complications (32 vs 33 %). Regarding the primary outcomes, group A had a better survival rate in comparison to group B (88.5 vs 78.8 %); however, this difference was not significant, with P-value of 0.173. Conclusions. In neonates with RDS, the routine INSURE method followed by CPAP gives no more superiority in outcomes (both primary, i.e. survival rate, and secondary, i.e. complications) than CPAP alone.

An IoT-based contactless neonatal respiratory monitoring system for neonatal care assistance in postpartum center

According to previous studies, one of the major causes of 20 % to 25 % of neonatal deaths is respiratory distress syndrome (RDS). Early identification, progressive monitoring, and treatment and/or management of neonatal RDS can substantially increase the rate of survival in neonates. However, global research indicates frequent shortages and burnout among nursing staff, especially in postpartum units, contributing to the difficulty in early identification of RDS in neonates. Clinicians currently use breathing sounds and frequency as key criteria in the Neonatal Resuscitation Program (NRP) for identifying and treating RDS. In practice, the monitoring of respiratory signal abnormalities relies on sensor patches, which frequently detach from the neonates’ slippery skin, leading to potential skin injuries and unstable signal reception. This paper presents an Internet of Things (IoT)-based contactless neonatal respiratory monitoring system that integrates computer vision (CV), beamforming microphone array (BFMA), and millimeter Wave (mmWave) radar, all connected to a cloud platform. Clinical trials revealed that CV-based neonatal feature identification achieved over 96 % accuracy within 40 cm to 120 cm. The neonatal breathing sound strengthening, utilized CV and BFMA, achieved an average sound-to-noise ratio (SNR) of 5.07 dB, and CV with mmWave radar reduced chest displacement signal error from 0.66 to 0.26 BPM. Additionally, survey results showed that doctors and clinical personnel were satisfied with the system's functionality and usability. This demonstrates the system's ability to assist in monitoring respiratory signals of swaddled neonates and in the early identification of neonatal RDS, with further applications in neonatal care at postpartum centers.

A nationwide survey on the management of neonatal respiratory distress syndrome: insights from the MUNICH survey in 394 Chinese hospitals

BackgroundAt present, preterm infants with respiratory distress syndrome (RDS) in China present higher mortality and morbidity rates than those in high-income countries. The aim of this nationwide survey was to assess the clinical management of RDS in China.MethodsA nationwide cross-sectional survey to assess adherence to RDS management recommendations was performed. One neonatologist per hospital was randomly selected. The primary outcome was the key care of RDS management.ResultsAmong the 394 participating hospitals, 88·3% were birthing centres. The number of doctors and nurses per bed were 0·27 and 0·72, respectively. Antenatal corticosteroids (any dose) were administered to 90% of the women at risk of preterm birth at < 34 weeks of gestation (90·0% inborn vs. 50·0% outborn, p < 0·001). The median fraction of inspired oxygen (FiO2) for initial resuscitation was 0·30 for babies born at ≤ 32 weeks of gestation and 0·25 for those born at > 32 weeks. T-piece resuscitators were available in 77·8% of delivery rooms (DRs) (tertiary hospitals: 82·5% vs. secondary hospitals: 63·0%, p < 0·001). Surfactant was used in 51·6% of the DRs. Less invasive surfactant administration (LISA) was used in 49·7% of the hospitals (tertiary hospitals: 55·3% vs. secondary hospitals: 31·5%, p < 0·001). Primary non-invasive ventilation was initiated in approximately 80·0% of the patients. High-frequency oscillation ventilation was primarily reserved for rescue after conventional mechanical ventilation (MV) failure. Caffeine was routinely used during MV in 59·1% of the hospitals. Bedside lung ultrasonography was performed in 54·3% of the health facilities (tertiary hospitals: 61·6% vs. secondary hospitals: 30·4%, p < 0·001). Qualified breast milk banks and Family Integrated Care (FICare) were present in 30·2% and 63·7% of the hospitals, respectively.ConclusionsSignificant disparities in resource availability and guidelines adherence were evident across hospitals. Future strategies should address DR facilities and medication access, technical training, staff allocation, and ancillary facility development for a better management of RDS patients in China.

Effectiveness and safety profile of introducing less invasive surfactant administration in management of respiratory distress syndrome: A retrospective cohort study in a tertiary neonatal unit in Hong Kong

BackgroundThe objective was to evaluate the efficacy of introducing less invasive surfactant administration (LISA) for management of preterm neonates with respiratory distress syndrome (RDS). MethodsThis was a retrospective cohort study identifying preterm neonates with RDS born between 2017 and 2022 in a tertiary neonatal unit, where LISA was introduced in January 2020. Time trend analysis comparing cohort of neonates born before (2017–2020) and after LISA introduction (2020–2022) was performed. The primary outcomes were incidence and severity of bronchopulmonary dysplasia (BPD). Multivariable regression models were used to estimate the association between introducing LISA to RDS management and health and safety outcomes. ResultsIn total, 261 neonates with RDS were included (114 born after LISA was introduced). Neonates receiving invasive surfactant administration had lower gestational age, birth weight, lower Apgar scores, and higher oxygen requirement, compared to those receiving LISA. In the time trend analysis, introduction of LISA was associated with lower incidence of BPD (odds ratio (95% confidence interval) 0.34 (0.16, 0.72)), and lower severity of BPD (0.31 (0.16, 0.59)). Pre- and post-LISA period showed similar treatment safety profiles. ConclusionIntroduction of LISA was associated with improved prognosis in neonates with RDS in Hong Kong.

Lesión pulmonar unilateral aguda secundaria a reexpansión pulmonar. Reporte de caso

Introduction: Lung reexpansion is a rare complication, generally less than 1%, that can occur after rapid drainage of a pneumothorax or pleural effusion. Its mortality can reach 20%.Clinical case: A 22-year-old female patient reported experiencing dizziness, weakness, vomiting containing food, presence of blood clots and bloody-looking stools, which is why she was taken to the hospital to the emergency department, and underwent surgery for upper digestive bleeding. In its evolution, it presents a picture of acute unilateral lung injury secondary to lung reexpansion when draining a pleural effusion. Medical and ventilatory treatment is imposed and the patient evolves favorably.Conclusions: Lung injury due to lung re-expansion is a rare entity; clinical suspicion is essential to act diligently and thus avoid complications. Good ventilatory management of Respiratory Distress Syndrome is essential, emphasizing protective mechanical ventilation and the appropriate use of PEEP

Driving pressure decoded: Precision strategies in adult respiratory distress syndrome management

Mechanical ventilation (MV) is an important strategy for improving the survival of patients with respiratory failure. However, MV is associated with aggravation of lung injury, with ventilator-induced lung injury (VILI) becoming a major concern. Thus, ventilation protection strategies have been developed to minimize complications from MV, with the goal of relieving excessive breathing workload, improving gas exchange, and minimizing VILI. By opting for lower tidal volumes, clinicians seek to strike a balance between providing adequate ventilation to support gas exchange and preventing overdistension of the alveoli, which can contribute to lung injury. Additionally, other factors play a role in optimizing lung protection during MV, including adequate positive end-expiratory pressure levels, to maintain alveolar recruitment and prevent atelectasis as well as careful consideration of plateau pressures to avoid excessive stress on the lung parenchyma.

Vayu bubble continuous positive airway pressure is a promising solution with favorable treatment outcomes for respiratory distress syndrome in newborns: a qualitative study in Bangladesh.

According to Bangladesh Demographic and Health Survey (2022), neonatal mortality, comprising 67% of under-5 deaths in Bangladesh, is significantly attributed to prematurity and low birth weight (LBW), accounting for 32% of neonatal deaths. Respiratory distress syndrome (RDS) is a prevalent concern among preterm and LBW infants, leading to substantial mortality. The World Health Organization (WHO) recommends bubble continuous positive airway pressure (bCPAP) therapy, but the affordability and accessibility of conventional bCPAP devices for a large number of patients become major hurdles in Bangladesh due to high costs and resource intensiveness. The Vayu bCPAP, a simple and portable alternative, offers a constant flow of oxygen-enriched, filtered, humidified, and pressurized air. Our study, conducted in five health facilities, explores the useability, acceptability, and perceived treatment outcome of Vayu bCPAP in the local context of Bangladesh. A qualitative approach was employed in special care newborn units (SCANUs) of selected facilities from January to March 2023. Purposive sampling identified nine key informants, 40 in-depth interviews with service providers, and 10 focus group discussions. Data collection and analysis utilized a thematic framework approach led by trained anthropologists and medical officers. Service providers acknowledged Vayu bCPAP as a lightweight, easily movable, and cost-effective device requiring minimal training. Despite challenges such as consumable shortages and maintenance issues, providers perceived the device as user-friendly, operable with oxygen cylinders, and beneficial during referral transportation. Treatment outcomes indicated effective RDS management, reduced hospital stays, and decreased referrals. Though challenges existed, healthcare providers and facility managers expressed enthusiasm for Vayu bCPAP due to its potential to simplify advanced neonatal care delivery. The Vayu bCPAP device demonstrated useability, acceptability, and favorable treatment outcomes in the care of neonates with RDS. However, sustained quality service necessitates continuous monitoring, mentoring and retention of knowledge and skills. Despite challenges, the enthusiasm among healthcare providers underscores the potential of Vayu bCPAP to save lives and simplify neonatal care delivery. Development of Standard Operating procedure on Vayu bCPAP is required for systematic implementation. Further research is needed to determine how the utilization of Vayu bCPAP devices enhances accessibility to efficient bCPAP therapy for neonates experiencing RDS.

Respiratory distress syndrome is associated with increased morbidity and mortality in late preterm births

Respiratory distress syndrome is strongly associated with prematurity, including late preterm births. Respiratory distress syndrome has been shown to be associated with certain neonatal morbidities and mortality, but these associations are not well described among late preterm births. We sought to determine the association between respiratory distress syndrome and adverse neonatal outcomes among late preterm (34-36 weeks) born singleton neonates. This is a retrospective cohort study using California's linked vital statistics and patient discharge data (2008-2019). We included singleton, nonanomalous births with a gestational age of 34-36 weeks. Outcomes of interest were interventricular hemorrhage, necrotizing enterocolitis, retinopathy of prematurity, neonatal sepsis, length of hospital stay, neonatal death, and infant death. Chi-square and multivariable Poisson regression analyses were used to examine the association of respiratory distress syndrome with outcomes at each gestational age. Adjusted risk ratio and 95% confidence interval values were estimated. A total of 242,827 births were included, of which 11,312 (4.7%) had respiratory distress syndrome. We found that among neonates with respiratory distress syndrome, necrotizing enterocolitis was higher at 35 weeks (adjusted risk ratio, 3.97 [95% confidence interval, 1.88-8.41]) and 36 weeks (adjusted risk ratio, 4.53 [95% confidence interval, 1.45-14.13]). Intraventricular hemorrhage, retinopathy of prematurity, neonatal sepsis, and length of hospital stay were significantly higher at 34-36 weeks of gestation in neonates with respiratory distress syndrome. Neonatal death was significantly higher among neonates with respiratory distress syndrome at 35 weeks (adjusted risk ratio, 3.04 [95% confidence interval, 1.58-5.85]) and 36 weeks (adjusted risk ratio, 3.25; 95% confidence interval, 1.59-6.68). In addition, infant death was significantly higher at 35 weeks (adjusted risk ratio, 2.27 [95% confidence interval, 1.43-3.61]) and 36 weeks (adjusted risk ratio, 2.60 [95% confidence interval, 1.58-4.28]). We found that respiratory distress syndrome was associated with intraventricular hemorrhage, retinopathy of prematurity, and sepsis at 34-36 weeks of gestation, whereas respiratory distress syndrome was associated with neonatal death, infant death, and necrotizing enterocolitis at 35 and 36 weeks. Clinicians should keep these outcomes in mind when making decisions about delivery timing, the potential benefits of antenatal steroids in pregnancies in the late preterm period, and the management of respiratory distress syndrome in late preterm neonates.

Updated Clinical Practice Guidelines in Resuscitation and the Management of Respiratory Distress Syndrome in Extremely Preterm Infants during Two Epochs in Romania: Impact on Outcomes.

Adequate perinatal management is essential in caring for extremely preterm (EP) infants. We aimed to evaluate and compare the impact of different protocols on short-term outcomes. A retrospective study was conducted on EP infants in a Romanian perinatal tertiary center during 2008-2012 and 2018-2022. Data on 270 EP infants (121 in period I, 149 in period II) were analyzed collectively and stratified into two subgroups by gestational age. Initial FiO2 administration (100% vs. 40%% p < 0.001), lung recruitment at birth (19.0% vs. 55.7% p < 0.001), early rescue surfactant administration (34.7% vs. 65.8%; p < 0.001), and the mechanical ventilation rate (98.3% vs. 58.4%; p < 0.001) were significantly improved during period II. Survival rates of EP infants significantly improved from 41.3% to 72.5%, particularly in the 26-28 weeks subgroup (63.8% to 83%). Compared to period I, the overall frequency of severe IVH decreased in period II from 30.6% to 14.1%; also, BPD rates were lower (36.6% vs. 23.4%; p = 0.045) in the 26-28 weeks subgroup. Despite improvements, there were no significant differences in the frequencies of NEC, sepsis, PVL, ROP, or PDA. Implementing evidence-based clinical guidelines can improve short-term outcomes.

A Survey of the Union of European Neonatal and Perinatal Societies on Neonatal Respiratory Care in Neonatal Intensive Care Units.

(1) Background: Our survey aimed to gather information on respiratory care in Neonatal Intensive Care Units (NICUs) in the European and Mediterranean region. (2) Methods: Cross-sectional electronic survey. An 89-item questionnaire focusing on the current modes, devices, and strategies employed in neonatal units in the domain of respiratory care was sent to directors/heads of 528 NICUs. The adherence to the "European consensus guidelines on the management of respiratory distress syndrome" was assessed for comparison. (3) Results: The response rate was 75% (397/528 units). In most Delivery Rooms (DRs), full resuscitation is given from 22 to 23 weeks gestational age. A T-piece device with facial masks or short binasal prongs are commonly used for respiratory stabilization. Initial FiO2 is set as per guidelines. Most units use heated humidified gases to prevent heat loss. SpO2 and ECG monitoring are largely performed. Surfactant in the DR is preferentially given through Intubation-Surfactant-Extubation (INSURE) or Less-Invasive-Surfactant-Administration (LISA) techniques. DR caffeine is widespread. In the NICUs, most of the non-invasive modes used are nasal CPAP and nasal intermittent positive-pressure ventilation. Volume-targeted, synchronized intermittent positive-pressure ventilation is the preferred invasive mode to treat acute respiratory distress. Pulmonary recruitment maneuvers are common approaches. During NICU stay, surfactant administration is primarily guided by FiO2 and SpO2/FiO2 ratio, and it is mostly performed through LISA or INSURE. Steroids are used to facilitate extubation and prevent bronchopulmonary dysplasia. (4) Conclusions: Overall, clinical practices are in line with the 2022 European Guidelines, but there are some divergences. These data will allow stakeholders to make comparisons and to identify opportunities for improvement.

Preterm Birth: A Review of Its Early Diagnosis and Prevention

Preterm birth, a major global healthcare concern, is characterized by infants being born before completing 37 weeks of gestation. Accurate diagnosis and effective interventions are critical to managing this complex issue. This abstract provides an overview of the diagnosis and prevention of preterm birth, focusing on risk assessment, diagnostic techniques, and various interventions for mothers and newborns. The diagnostic process involves evaluating risk factors, clinical history, and the assessment of potential membrane rupture. Techniques such as speculum examination, the Nitrazine test, the Fern test, ultrasonography, and the Placental Alpha Microglobulin-1 test play vital roles in identifying membrane rupture and infection. Additional diagnostic markers include cervical ultrasonography and fetal fibronectin testing. Prevention strategies include lifestyle changes, maternal therapies, and antenatal interventions. Smoking cessation programs, low-dose aspirin, antenatal corticosteroid therapy, progesterone supplementation, magnesium sulfate, and antibiotic treatment are employed to reduce the risk of preterm birth. Cervical cerclage, another surgical intervention, is recommended in specific cases.&#x0D; For preterm newborns, immediate and effective care is vital. This includes thermal care, early breastfeeding, infection prevention, and respiratory distress syndrome management. These interventions are crucial in reducing infant mortality and morbidity associated with preterm birth. Efforts to diagnose and prevent preterm birth are essential in improving the well-being of both mothers and their newborns. A comprehensive approach, combining accurate diagnosis and effective interventions, can make a significant impact in reducing the burden of preterm birth on healthcare systems and families.&#x0D; Keywords: Preterm birth, infants, gestation, potential membrane rupture

European Consensus Guidelines on the Management of Respiratory Distress Syndrome, 2022 : What is New?

European Consensus Guidelines on the Management of Respiratory Distress Syndrome, 2022 : What is New?

Management of Respiratory Distress Syndrome: Clinical Implications from Recent European Consensus Guidelines

Respiratory distress syndrome (RDS) is the most common major morbidity in preterm infants. The recent 6th edition of European consensus guidelines (2023) on RDS gives comprehensive care pathways for management of this vulnerable population based on updated evidence until the end of 2022. The current update also aims to highlight the major updates from the previous version (2019) and to compare the surfactant and non-invasive respiratory support guidelines from the National Neonatology Forum, India.

Lung UltrasouNd Guided surfactant therapy in preterm infants: an international multicenter randomized control trial (LUNG study)

BackgroundThe management of respiratory distress syndrome (RDS) in premature newborns is based on different types of non-invasive respiratory support and on surfactant replacement therapy (SRT) to avoid mechanical ventilation as it may eventually result in lung damage. European guidelines currently recommend SRT only when the fraction of inspired oxygen (FiO2) exceeds 0.30. The literature describes that early SRT decreases the risk of bronchopulmonary dysplasia (BPD) and mortality. Lung ultrasound score (LUS) in preterm infants affected by RDS has proven to be able to predict the need for SRT and different single-center studies have shown that LUS may increase the proportion of infants that received early SRT.Therefore, the aim of this study is to determine if the use of LUS as a decision tool for SRT in preterm infants affected by RDS allows for the reduction of the incidence of BPD or death in the study group.Methods/designIn this study, 668 spontaneously-breathing preterm infants, born at 25+0 to 29+6 weeks’ gestation, in nasal continuous positive airway pressure (nCPAP) will be randomized to receive SRT only when the FiO2 cut-off exceeds 0.3 (control group) or if the LUS score is higher than 8 or the FiO2 requirements exceed 0.3 (study group) (334 infants per arm). The primary outcome will be the difference in proportion of infants with BPD or death in the study group managed compared to the control group.DiscussionBased on previous published studies, it seems that LUS may decrease the time to administer surfactant therapy. It is known that early surfactant administration decreases BPD and mortality. Therefore, there is rationale for hypothesizing a reduction in BPD or death in the group of patients in which the decision to administer exogenous surfactant is based on lung ultrasound scores.Trial registrationClinicalTrials.gov identifier NCT05198375. Registered on 20 January 2022.

Bocavirus and rotavirus co-infection in children with acute gastroenteritis and associated risk factors

Background: Both Viruses are the leading cause of acute gastroenteritis in infants and young children and are considered an important cause of mortality worldwide. &#x0D; Objective: To estimate the rate of human bocavirus and rotavirus co-infection in children with acute gastroenteritis and determine any association with different risk factors.&#x0D; Patients and Methods: Stool samples were collected from one hundred children suffering from acute gastroenteritis at the Central Teaching Hospital of Pediatrics, Baghdad, Iraq, for the period from December 2021 to April 2022. Samples were stored at -20 °C until they were utilized by PCR and ELISA to identify the human bocavirus (HBoV) DNA and rotavirus antigen (RV-Ag), respectively.&#x0D; Results: This cross-sectional study showed that HBoV DNA was detected in 10 out of 100 samples (10%), while RV-Ag was detected in 22 out of 93 samples (23.66%), and the co-infection rate was 100% (All cases positive for HBoV were also positive for RV). None of the studied demographic data and risk factors showed a significant association with HBoV and/or rotavirus infection (P&gt;0.05).&#x0D; Conclusion: Most NICU deaths resulted from prematurity and respiratory distress syndrome. Enhancing healthcare personnel skills, standardizing protocols, and evidence-based practices for preterm and respiratory distress syndrome management can help reduce neonatal mortality rates in Iraq.

Bocavirus and rotavirus co-infection in children with acute gastroenteritis and associated risk factors

Background: Both Viruses are the leading cause of acute gastroenteritis in infants and young children and are considered an important cause of mortality worldwide. Objective: To estimate the rate of human bocavirus and rotavirus co-infection in children with acute gastroenteritis and determine any association with different risk factors. Patients and Methods: Stool samples were collected from one hundred children suffering from acute gastroenteritis at the Central Teaching Hospital of Pediatrics, Baghdad, Iraq, for the period from December 2021 to April 2022. Samples were stored at -20 °C until they were utilized by PCR and ELISA to identify the human bocavirus (HBoV) DNA and rotavirus antigen (RV-Ag), respectively. Results: This cross-sectional study showed that HBoV DNA was detected in 10 out of 100 samples (10%), while RV-Ag was detected in 22 out of 93 samples (23.66%), and the co-infection rate was 100% (All cases positive for HBoV were also positive for RV). None of the studied demographic data and risk factors showed a significant association with HBoV and/or rotavirus infection (P&gt;0.05). Conclusion: Most NICU deaths resulted from prematurity and respiratory distress syndrome. Enhancing healthcare personnel skills, standardizing protocols, and evidence-based practices for preterm and respiratory distress syndrome management can help reduce neonatal mortality rates in Iraq. Keywords: Human bocavirus, rotavirus, acute gastroenteritis, risk factors, co-infection

Feasibility, safety and efficacy of COVID-19 severe acute respiratory distress syndrome management without invasive mechanical ventilation.

COVID-19 acute respiratory distress syndrome (ARDS) is often managed with mechanical ventilation (MV), requiring sedation and paralysis, with associated risk of complications. There is limited evidence on the use of high flow nasal cannula (HFNC). We hypothesized that management of COVID-19 ARDS without MV is feasible. Included were all adult patients diagnosed with COVID-19 ARDS, with PaO<inf>2</inf>/FiO<inf>2</inf> ratio <100 at admission, and whose management was initially performed without MV. We evaluated need for intubation during ICU stay, mortality and hospital/ICU length of stay (LOS). Out of 118 patients, 41 were managed only with HFNC from hospital admission (and at least during first 24 hours in ICU) and had a PaO<inf>2</inf>/FiO<inf>2</inf> ratio <100 (72.9±13.0). 29/41 patients never required MV: 24 of them survived and were discharged home. Their median ICU LOS was 11 (7-17) days, and their hospital LOS was 29 (18-45) days. We identified PaO<inf>2</inf>/FiO<inf>2</inf> ratio at ICU admission as the only significant predictor for need for MV during ICU stay. We also identified age, length of non-invasive respiratory support before ICU admission, mean value of PaO<inf>2</inf>/FiO<inf>2</inf> ratio during first half and whole ICU stay as predictors of mortality. It is safe to monitor in ICU and use HFNC in patients affected by COVID-19 ARDS who initially present data suggesting an early need for intubation. The 41 patients admitted with a PaO<inf>2</inf>/FiO<inf>2</inf> ratio <100 and initially treated only with HFNC show a 22% mortality that is in the lower range of what is reported in recent literature.

Interpretation of the key updates in the 2022 European guideline on the management of neonatal respiratory distress syndrome

With the deepening of clinical research, the management of neonatal respiratory distress syndrome (RDS) needs to be optimized and improved. This article aims to introduce the 2022 European guideline on the management of neonatal RDS, focusing on its key updates. The guide has optimized the management of risk prediction for preterm birth, maternal referral, application of prenatal corticosteroids, application of lung protective ventilation strategies, and general care for infants with RDS. The guideline is mainly applicable to the management of RDS in neonates with gestational age greater than 24 weeks.