Treatment and respiratory support modes for neonates with respiratory distress syndrome

ABSTRACT

Introduction

Respiratory distress syndrome (RDS) remains an important problem. Identifying effective treatments and respiratory support modes is essential.

Areas covered

Current treatments and respiratory support modes and the evidence base for new therapies and respiratory modes have been examined.

Methods

A literature search was undertaken using PubMed and Google Scholar.

Expert opinion

It is now common to stabilise infants on non-invasive respiratory support in the delivery suite and give early selective surfactant to infants with RDS. Increasingly, less invasive surfactant administration is used. Systemically administered corticosteroids should not be given in the perinatal period; inhaled budesonide has been associated with an increased mortality. Inhaled nitric oxide can be helpful in preterm infants with pulmonary hypertension. Caffeine should be routinely administered. Further research regarding stems cells is required. Post extubation, nasal intermittent positive pressure ventilation (NIPPV) rather than nasal continuous positive airway pressure (nCPAP) provides better support and humidified high flow nasal cannula (HHFNC) has similar efficacy to continuous positive airway pressure (CPAP). Volume targeting should be used for infants requiring intubation. There is insufficient evidence to determine the role of neurally adjusted ventilatory assist or whether closed loop automatic oxygen control improves long term outcomes.

KEYWORDS:

• Surfactant
• less invasive surfactant administration (LISA)
• nebulization
• corticosteroids
• nitric oxide
• caffeine
• continuous positive airway pressure
• heated
• humidified
• high flow nasal cannula
• high frequency oscillatory ventilation
• patient triggered ventilation
• volume targeted ventilation
• closed loop automatic oxygen control

Article highlights

• The efficacy of surfactant preparations has been examined, including the newer synthetic preparations.

• The results of different modes of surfactant administration have been discussed.

• The impact and side-effects of administering corticosteroids are reviewed.

• The evidence for efficacy of non-invasive and invasive respiratory support techniques in prematurely born infants has been reviewed.

• It is highlighted that the important further RCTs should incorporate long-term follow-up, at least until 2 years.

This box summarizes key points contained in the article.

Declaration of interest

A Greenough has held grants from various ventilator manufacturers and received honoraria for giving lectures and advising various ventilator manufacturers. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Additional information

Funding

This paper was supported by the National Institute for Health Research (NIHR) Biomedical Research Centre based at Guy’s and St Thomas’ NHS Foundation Trust and King’s College London. The views expressed are those of the author(s) and not necessarily those of the NHS, the NIHR, or the Department of Health.