Sweet David, Bevilacqua Giulio, Carnielli Virgilio, Greisen Gorm, Plavka Richard, Saugstad Ola Didrik, Simeoni Umberto, Speer Christian P, Valls-I-Soler Adolf, Halliday Henry
Regional Neonatal Unit, Royal Maternity Hospital, Belfast, Northern Ireland, UK.
J Perinat Med. 2007;35(3):175-86. doi: 10.1515/JPM.2007.048.
Despite recent advances in the perinatal management of neonatal respiratory distress syndrome (RDS), controversies still exist. We report the recommendations of a European panel of expert neonatologists who developed consensus guidelines after critical examination of the most up-to-date evidence in 2007. Strong evidence exists for the role of antenatal steroids in RDS prevention, but it is not clear if repeated courses are safe. Many practices involved in preterm neonatal stabilization at birth are not evidence based, including oxygen administration and positive pressure lung inflation, and they may at times be harmful. Surfactant replacement therapy is crucial in management of RDS but the best preparation, optimal dose and timing of administration at different gestations is not always clear. Respiratory support in the form of mechanical ventilation may also be life saving but can cause lung injury, and protocols should be directed to avoiding mechanical ventilation where possible by using nasal continuous positive airways pressure. For babies with RDS to have the best outcome, it is essential that they have optimal supportive care, including maintenance of a normal body temperature, proper fluid management, good nutritional support, management of the ductus arteriosus and support of the circulation to maintain adequate blood pressure.
尽管新生儿呼吸窘迫综合征（RDS）围产期管理方面近来有所进展，但争议仍然存在。我们报告了一个欧洲新生儿专家小组的建议，该小组在对2007年最新证据进行严格审查后制定了共识指南。有强有力的证据表明产前使用类固醇对预防RDS有作用，但重复用药是否安全尚不清楚。许多出生时早产儿稳定治疗的做法缺乏循证依据，包括给氧和正压通气，而且有时可能有害。表面活性剂替代疗法对RDS的治疗至关重要，但不同孕周的最佳制剂、最佳剂量和给药时机并不总是明确的。机械通气形式的呼吸支持也可能挽救生命，但会导致肺损伤，应制定方案尽可能通过使用鼻持续气道正压通气来避免机械通气。为使患有RDS的婴儿获得最佳预后，至关重要的是要给予最佳的支持性护理，包括维持正常体温、适当的液体管理、良好营养支持、动脉导管管理以及维持足够血压的循环支持。
