NOVELTIES IN THE TREATMENT OF RESPIRATORY DISTRESS SYNDROME

Selma Muratović, Alma Merić, Ivana Stijepić

Abstract


Method of care and treatment of RDS in premature children has been revised according to European guidelines in 2013.The latest recommendations relate to prevention of prematurity; transport of mothers at risk of premature birth in the tertiary care centers;prenatal corticosteroids to mothers at risk (23-34 GW) and mothers who will have CS before the due date,repeat dose of corticosteroids,if pregnancy is < 33 GW;antibiotic in case of ruptured membranes;tocolytics in order to effects of corticosteroids and transport to larger center. Recommendations at the birth-delayed clamping at least 60 seconds,which enhances placental-fetal transfusions;maintaining the oxygen concentration 21- 30% in the beginning of stabilization;stabilizing with CPAP through mask or nasal cannula;intubation and surfactant to infants who did not positively respond to CPAP;reduce risk of hypothermia in infants <28 GW.The surfactant should be given to infants < 26 GW, FIO2> 0.30,and in infants > 26 GW,FiO2> 0.40;apply the bolus through endotracheal tube for infants on MV;insist on non-invasive ventilation in application of surfactant using new techniques:INSURE,TakeCare procedure;modern membrane nebulizer.The aim is to shorten the length of  MV early therapy caffeine citrate,maintaining permissive hypercarbia and postnatal application of steroids which affect reduction of brochopulmonary dysplasia and neurodevelopmental sequelae.There are necessary supportive measures: antibiotic therapy to exclude sepsis,maintaining normal temperature,parenteral route with minimal enteral nutrition,monitoring blood pressure and tissue perfusion (inotropes) and pharmacologically persistent closure of ductus.Studies conducted in recent years have significantly influenced our clinical practice in treatment and stabilization of preterm neonates with RDS.

Key words: Respiratory distress syndrome, surfactant, premature infants, CPAP.



DOI: 10.5457/ams.v45iSuppl. 1.375