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The management of neonatal respiratory distress syndrome in preterm infants (European Consensus Guidelines—2013 update)
  1. S Sakonidou1,
  2. J Dhaliwal2
  1. 1Department of Neonatology, King's College Hospital Foundation Trust, London, UK
  2. 2Chelsea and Westminster Hospital, London, UK
  1. Correspondence to Dr J Dhaliwal, Chelsea and Westminster Hospital, London, UK; jazz_dhaliwal{at}hotmail.com

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Information about current guideline

In May 2013, a European panel of expert neonatologists published a consensus guideline on the management of respiratory distress syndrome (RDS) in the Journal of Neonatology.1 The aim of the guideline was to provide recommendations based on the most up-to-date evidence in the perinatal management of RDS to maximise survival while minimising potential adverse effects.

Previous guideline

The first edition of the European Consensus Guidelines on the Management of Neonatal RDS was published in 2007 in the Journal of Perinatal Medicine.2 The recommendations were subsequently updated, and a second edition was published in 2010 in the Journal of Neonatology.3

Underlying evidence base

This third edition of the guidelines incorporates evidence published up to the end of 2012. A system for grading the scientific evidence (GRADE) has been used.4 The European Association of Perinatal Medicine has endorsed all three guideline editions.

Controversial and key issues that the guideline addresses:

  • Prenatal care:

    • A single course of prenatal corticosteroids should be offered to all women at risk of preterm delivery from about 23 weeks up to 34 completed weeks’ gestation (A).

    • A second course of steroids may be appropriate if the baby is <33 weeks' gestation and the first course given >2–3 weeks earlier (A). To note beyond 14 days after the administration of antenatal steroids, the benefits are diminished.

    • Birth should be ideally delayed to allow the maximum benefit of prenatal corticosteroid therapy (B). The short-term use of tocolytic drugs should be considered to delay preterm delivery to allow completion of prenatal corticosteroids and/or in utero transfer to perinatal centre (B).

    • To consider discussing the use of antenatal steroids for women up to term, before an elective caesarean section as they reduce the potential risk of admission to the neonatal unit (B). However, the potential long-term risk of steroids is a significant factor to …

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