Servicio de Neonatología, Hospital Universitario Miguel Servet, Zaragoza, Spain.
Servicio de Neonatología, Hospital Clínico Universitario Virgen de la Arrixaca, El Palmar, Murcia, Spain.
An Pediatr (Engl Ed). 2024 Nov;101(5):319-330. doi: 10.1016/j.anpede.2024.10.003. Epub 2024 Nov 1.
Respiratory distress syndrome (RDS) is the most frequent cause of respiratory distress in preterm neonates. In the management of RDS, surfactant plays a pivotal role, but there are no evidence-based recommendations for moderate/late preterm neonates (32-36 weeks).
A scientific committee developed a questionnaire with 53 questions addressing diagnosis, treatment, potential complications and future trends in RDS specifically focused on moderate and late preterm neonates. This was followed by the performance of a Delphi survey of expert neonatologists.
Consensus was reached on 98 of the 109 items. The recommendations for the diagnosis of RDS included performing a lung ultrasound and including mild respiratory distress, transient tachypnoea of the newborn, congenital pneumonia and primary pulmonary hypertension in the differential diagnosis. Most panellists agreed on the need for studies that determine the benefit/harm balance, clinical profile and methods of surfactant administration in moderate/late preterm neonates. All respondents would use the MIST approach with devices specifically designed for surfactant administration. Regarding sedation measures during MIST, most participants agreed on the use of nonpharmacological interventions and, if these proved ineffective, an opioid. All respondents agreed that moderate/late preterm neonates are at increased risk of neonatal morbidity and mortality, particularly respiratory problems, and considered the need for more specialised monitoring in hospital follow-up visits in neonates with associated risk factors or a history of complications in the neonatal period. Finally, all respondents agreed that there is a lack of studies identifying risk factors and medium-term adverse outcomes in moderate/late preterm neonates.
This expert consensus will help with the diagnosis and management of RDS and guide decision-making about surfactant administration in moderate/late preterm neonates.
呼吸窘迫综合征（RDS）是早产儿最常见的呼吸窘迫原因。在 RDS 的管理中，表面活性剂起着关键作用，但对于中度/晚期早产儿（32-36 周），尚无基于证据的推荐意见。
一个科学委员会制定了一份包含 53 个问题的问卷，专门针对中度和晚期早产儿 RDS 的诊断、治疗、潜在并发症和未来趋势。随后对专家新生儿科医生进行了 Delphi 调查。
在 109 项中的 98 项上达成了共识。RDS 的诊断建议包括进行肺部超声检查，并将轻度呼吸窘迫、新生儿短暂性呼吸急促、先天性肺炎和原发性肺动脉高压纳入鉴别诊断。大多数专家认为需要进行研究，以确定中度/晚期早产儿中表面活性剂的获益/危害平衡、临床特征和给药方法。所有受访者都将使用专为表面活性剂给药设计的设备采用 MIST 方法。关于 MIST 期间的镇静措施，大多数参与者都同意使用非药物干预措施，如果这些措施无效，则使用阿片类药物。所有受访者都认为中度/晚期早产儿有更高的新生儿发病率和死亡率风险，特别是呼吸问题，并认为在新生儿期有相关危险因素或有并发症病史的婴儿的医院随访中需要更专门的监测。最后，所有受访者都认为缺乏识别中度/晚期早产儿风险因素和中期不良结局的研究。
本专家共识将有助于 RDS 的诊断和管理，并指导中度/晚期早产儿表面活性剂给药的决策。
