University of Oulu

David G. Sweet, Virgilio P. Carnielli, Gorm Greisen, Mikko Hallman, Katrin Klebermass-Schrehof, Eren Ozek, Arjan te Pas, Richard Plavka, Charles C. Roehr, Ola D. Saugstad, Umberto Simeoni, Christian P. Speer, Maximo Vento, Gerry H.A. Visser, Henry L. Halliday; European Consensus Guidelines on the Management of Respiratory Distress Syndrome: 2022 Update. Neonatology 2 March 2023; 120 (1): 3–23.

European consensus guidelines on the management of respiratory distress syndrome : 2022 update

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Author: Sweet, David G.1; Carnielli, Virgilio P.2; Greisen, Gorm3;
Organizations: 1Regional Neonatal Unit, Royal Maternity Hospital, Belfast, UK
2Department of Neonatology, University Polytechnic Della Marche, University Hospital Ancona, Ancona, Italy
3Department of Neonatology, Rigshospitalet and University of Copenhagen, Copenhagen, Denmark
4Department of Children and Adolescents, Oulu University Hospital and Medical Research Center, University of Oulu, Oulu, Finland
5Department of Pediatrics and Adolescent Medicine, Division of Neonatology, Medical University of Vienna, Vienna, Austria
6Department of Pediatrics, Marmara University Medical Faculty, Istanbul, Turkey
7Leiden University Medical Centre, Leiden, The Netherlands
8Division of Neonatology, Department of Obstetrics and Gynecology, General Faculty Hospital and 1st Faculty of Medicine, Charles University, Prague, Czechia
9Faculty of Health Sciences, University of Bristol, UK and National Perinatal Epidemiology Unit, Oxford Population Health, Medical Sciences Division, University of Oxford, Oxford, UK
10Department of Pediatric Research, Oslo University Hospital Rikshospitalet, University of Oslo, Oslo, Norway
11Ann and Robert H. Lurie Children’s Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
12University of Lausanne, Lausanne, Switzerland
13Department of Pediatrics, University Children’s Hospital, Wuerzburg, Germany
14Department of Pediatrics and Neonatal Research Unit, Health Research Institute La Fe, University and Polytechnic Hospital La Fe, Valencia, Spain
15Department of Obstetrics and Gynecology, University Medical Centre, Utrecht, The Netherlands
16Department of Child Health, Queen’s University Belfast and Royal Maternity Hospital, Belfast, UK
Format: article
Version: published version
Access: open
Online Access: PDF Full Text (PDF, 0.5 MB)
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Language: English
Published: Karger, 2023
Publish Date: 2023-08-10


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 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).

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Series: Neonatology
ISSN: 1661-7800
ISSN-E: 1661-7819
ISSN-L: 1661-7800
Volume: 120
Issue: 1
Pages: 3 - 23
DOI: 10.1159/000528914
Type of Publication: A1 Journal article – refereed
Field of Science: 3123 Gynaecology and paediatrics
Funding: This project was supported by an unrestricted educational grant provide by Chiesi Pharmaceuticals through UENPS to support travel for a single face-to-face meeting in Belfast during guideline preparation.
Copyright information: © 2023 The Author(s). Published by S. Karger AG, Basel. This article is licensed under the Creative Commons Attribution 4.0 International License (CC BY) ( Usage, derivative works and distribution are permitted provided that proper credit is given to the author and the original publisher.