1、European Consensus Guidelines on the Management of Neonatal Respiratory Distress Syndrome in Preterm infants-2010 UpdatePrenatal Care产前治疗oMothers at high risk of preterm birth should be transferred to perinatal centres with experience in management of RDS(C).o有早产高危因素的母亲应被转运至对处理新生儿呼吸窘迫综合症有丰富经验的医疗中心。o
2、Clinicians should offer a single course of antenatal steroids to all women at risk of preterm delivery from about 23weeks up to 35 completed weeks gestation (A).o对于孕23周至35周有早产高危因素的母亲，医生均应使用一疗程产前激素。oAntibiotics should be given to mothers with preterm pre-labour rupture of the membranes as this reduce
3、s the risk of preterm delivery (A).o对于有早产高危因素合并胎膜早破的孕妇，抗生素的使用可减少早产的发生。oClinicians should consider short-term use of tocolytic drugs to allow completion of a course of antenatal steroids and/or in utero transfer to a perinatal centre (A).o医生应考虑短期使用抗分娩药物，使产前激素疗程可完成/能及时转运至医疗中心。oA second course of anten
4、atal steroids should be considered if the risk from RDS is felt to outweigh the uncertainty about possible long-term adverse effects (D). One example where benefit might outweigh the risk is multiple pregnancy (C).o若考虑发生新生儿呼吸窘迫综合征的危险大于使用激素产生长期副作用的不确定性，应考虑使用第二疗程的产前激素。其中一个利大于弊的例子是多胎妊娠。Delivery Room St
5、abilisationoIf possible, delay clamping of the umbilical cord for at least 30-45 s with the baby held below the mother to promote placento-fetal transfusion (A).o如果可能，延迟钳夹脐带30-45秒，且使婴儿位置低于母亲，有利于母-婴输血。oOxygen for resuscitation should be controlled by using an air-oxygen blender. The lowest concentrat
6、ion of oxygen possible should be used during stabilisation, provided there is an adequate heart rate response. A concentration of 30% oxygen is appropriate to start stabilisation and adjustments up or down should be guided by applying pulse oximetry from birth to give information on heart rate (B).
7、Normal saturations during transition immediately after birth in very preterm infants may be between 40 and 60%, reaching between 50 and 80% at 5 min of age and should be 85% by 10 min of age. Exposure to hyperoxia should be avoided during stabilisation (B).o复苏时氧气浓度需用空气-氧气混合器控制。需要使用最低的氧浓度达到使婴儿稳定的目的（合
8、适的心率）。30%的氧浓度作为复苏起始的氧浓度较适宜，然后根据脉搏-氧饱和度仪提供心率的信息作出调整。对于极早产儿，生后立即的氧饱和度大约为40-60%，5分钟时上升至50-80%，10分钟时应85%。应避免复苏时高氧的暴露。oIn spontaneously breathing babies start stabilisation with CPAP of at least 5-6 cm H2O via mask or nasal prongs (B). If breathing is insufficient, consider the use of a sustained inflati
9、on breath to recruit the lung rather than intermittent positive pressure breaths (B).o对于自主呼吸好的婴儿,面罩/鼻塞持续正压通气时最少使用5-6cm水柱的呼气末正压。若自主呼吸不足，持续通气优于间歇正压通气。oVentilation with a T-piece device is preferable to a self-in-flating, or flow-flating bag in order to generate appropriate positive end-expiratory pres
10、sure (PEEP) (C).o使用T管优于球囊因为它可以维持一个合适的呼气末正压。oIf positive pressure ventilation is needed for stabilisation, aim to avoid excessive tidal volumes by incorporating resuscitation devices which measure of limit the PIP whilst at the same time maintaining PEEP during expiration (D).o如果需要正压通气维持病情的稳定，目标是通过限制
11、吸气峰压和维持呼气末正压来避免过度通气。oIntubation should be reserved for babies who have not responded to positive pressure ventilation or those requiring surfactant therapy (D).o当无创正压通气无效或需要使用肺表面活性物质治疗时，需考虑气管插管。oIf the baby is intubated, correct positioning of the endotracheal tube should be verified by colorimetric
12、 CO2 detection (D).o当气管插管时，需根据二氧化碳分压调整气管插管深度。oPlastic bags or occlusive wrapping under radiant warmers should be used during stabilisation in the delivery suite for babies 28 weeks gestation to reduce the risk of hypothermia (A).o胎龄小于28周的早产儿复苏过程中在辐射抢救台上需使用塑料薄膜包裹以减少低体温的发生。Surfactant Therapy肺表面活性药物oBa
13、bies with or at high risk of RDS should be given a natural surfactant preparation (A).o患新生儿呼吸窘迫综合症或有该病高危因素的婴儿需备好天然的肺表面活性药物。oProphylaxis (within 15 min of birth) should be given to almost all babies of 26 weeks gestation. Prophylaxis should also be given to all preterm babies with RDS who require int
14、ubation for stablisation (A).o胎龄26周的早产儿几乎都需要预防性使用肺表面活性药物（生后15min内）。所有患有新生儿呼吸窘迫综合症且需要插管的早产儿均需要预防性使用肺表面活性物质。oEarly rescue surfactant should be administered to previously untreated babies if there evidence of RDS (A). Individual units need to develop protocols for when to intervene as RDS progresses de
15、pending on gestational age and prior treatment with antenatal steroids (D). Poractant alfa in an initial does of 200 mg/kg is better than 100 mg/kg of poractant alfa or beractant for treatment of moderate to severe RDS (B).o当有新生儿呼吸窘迫综合症的证据且未使用肺表面活性物质的早产儿，应尽早应用治疗性的肺表面活性物质。不同机构需根据胎龄及产前激素的使用来制定新生儿呼吸窘迫综
16、合症的干预策略。对于中至重度的新生儿呼吸窘迫综合症，首剂200毫克/公斤的猪肺表面活性物质/贝拉康坦优于100毫克/公斤。oConsider immidiate ( or early) extubation to non-invasive respiratory support (CPAP or nasal intermittent positive pressure ventilation (NIPPV) following surfactant administration provided the baby is otherwise stable (B).o当婴儿病情稳定时，建议使用肺表
17、面活性物质后立即或尽早拔除气管插管，改为无创呼吸支持（持续正压通气或鼻塞间歇正压通气）。oA second, and sometimes a third dose of surfactant should be administered if there is ongoing evidence of RDS such as a persistent oxygen requirement and need for MV (A).o当新生儿呼吸窘迫综合症继续进展（表现为持续需氧或需要机械通气），需考虑第二剂甚至第三剂肺表面活性物质的使用。Oxygen Supplementation beyond
18、StabilisationoIn babies receiving oxygen, saturation should be maintained between 85 and 93% (D).o早产儿的氧饱和度需维持在85-93%之间。oAfter giving surfactant avoid a hyperoxic peak by rapid reduction in FiO2 (C).o使用肺表面活性物质后注意避免急速下调供氧浓度。oAvoid fluctuations in SaO2 in the postnatal period (D).o避免生后氧饱和度的波动。Role of C
19、PAP in Management of RDSoCPAP should be started from birth in all babies at risk of RDS, such as those 30 weeks gestation who do not need MV, until their clinical status can be assessed (D).o所有有新生儿呼吸窘迫综合症高危因素的早产儿应首选持续正压通气，例如胎龄小于30周无需呼吸机辅助呼吸者，直至临床表现稳定后。oShort binasal prongs should be used rather than
20、 a single prong as they reduce the need for intubation and a pressure of at least 5 cm H2O should be applied (A).o双鼻塞优于单鼻塞（呼气末正压至少需达到5厘米水柱），因为它能减少插管的需要。oThe use of CPAP with early rescue surfactant should be considered in babies with RDS in order to reduce the need for MV (A).o患新生儿呼吸窘迫综合症的患儿早期应用肺表后直
21、接应用持续正压通气可减少呼吸机的使用。Mechanical Ventilation Strategies呼吸机策略oMV should be used to support babies with respiratory failure as this improves survival (A).o呼吸衰竭时需使用呼吸机辅助呼吸，增加生存率。oAvoid hypocapnia as this is associated with increased risks of BPD and periventricular leucomalacia (B).o避免低碳酸血症，因为它与慢性肺疾病及脑室周围
22、白质软化相关。oSettings of MV should be adjusted frequently with the aim of maintaining optimum lung volume (C).o呼吸机的参数需不断的调整，目标是维持理想的肺容量。oDuration of MV should be minimised to reduce its injurious effect on lung (B).o尽量减少呼吸机通气的时间，减轻肺损伤。Avoiding or Reducing Duration of Mechanical Ventilation避免或缩短使用呼吸机oCaff
23、eine should be used in babies with apnoea and to facilitate weaning from MV (A). Caffeine should be considered for all babies at high risk of needing ventilation, such as those 1,250 g birth weight, who are managed on CPAP or NIPPV (B).o有呼吸暂停或准备撤机的患儿，应使用咖啡因。咖啡因应使用于所有有上机高危因素的患儿，例如出生体重小于1250克，正在使用持续正压
24、通气或鼻塞间歇正压通气者。oCPAP or NIPPV should be used preferentially to avoid or reduce the duration of MV through an endotracheal tube (B).o为了避免或缩短气管插管呼吸机辅助通气的时间，应优先选用持续正压通气或鼻塞间歇正压通气。oWhen weaning from MV it is reasonable to tolerate a moderate degree of hypercapnia, provided the pH remains above 7.22 (D).o当撤
25、机后，容许允许性高碳酸血症的存在（血气PH需维持在7.22以上）。oSynchronised and targeted tidal volume modes of conventional ventilation with an aggressive weaning approach should be used to shorten duration of MV (B).o应该使用同步及容量保证的常频呼吸机模式加上一个积极的撤机方法来缩短使用呼吸机的时间。Prophylactic Treatment for Sepsis败血症的预防性治疗oAntibiotics should be star
26、ted in babies with RDS until sepsis has been ruled out. A common regimen includes penicillin/ampicillin in combination with an aminoglycoside, however, individual units should develop local protocols for antibiotic use based on the profile of bacterial pathogens causing early onset sepsis (D).o患新生儿呼
27、吸窘迫综合症的患儿需预防性使用抗生素直至除外败血症。常见的药物是青霉素或氨苄西林联合氨基糖苷类 ，然而，各机构需根据导致早发败血症的各自的细菌病原谱选择抗生素。oUnits should develop protocols for antifungal prophylaxis in very preterm babies based on the local incidence and risk factors (D).o不同的机构需要根据当地的真菌感染发生率及危险因素建立极早产儿预防性使用抗真菌药物的规则。Supportive Care 支持治疗oBody temperature shoul
28、d be maintained at 36.5-37.5 oC at all times (C).o体温需一直维持在36.5-37.5 oC 。oMost babies should be started on intravenous fluids of 70-80 ml/kg/day while being kept in a humidified incubator (D).o生后第一天给予70-80ml/公斤/天的静脉液体（处于保湿暖箱中）。oFluid and electrolyte therapy should be tailored individually in preterm
29、infants, allowing a 2.5-4% daily weight loss (15% total) over the first 5 days (D).o早产儿液体及电解质的供给需个体化，允许生后头五天每天2.5-4%的体重下降（总共15%）。oSodium intake should be restricted over the first few days of life and initiated after the onset of diuresis with careful monitoring of fluid balance and electrolyte leve
30、ls (B).o生后头几天需限制钠盐的供给，当尿量增多后在密切监测出入量及电解质水平后可开始给予。oFull parenteral nutrition can be initiated on day 1 (A). This may include starting protein at 3.5 g/kg/day and lipid at 3 g/kg/day in 10% dextrose solution.o全量胃肠外营养可于生后第一天开始。这包括蛋白质3.5 g/kg/day 及脂肪3 g/kg/day ，加入10%的糖水中。oMinimal enteral feeding should
31、be started from the first day (B). Early aggressive feeding is increasingly popular but level A evidence of its benefit is lacking.o少量肠内喂养应在生后第一天开始。早期快速增加喂养越来越流行，但缺乏A类证据的支持。oTreatment of arterial hypotension is recommended when it is confirmed by evidence of poor tissue perfusion (C).o组织灌注不良导致的低血压是需
32、要治疗的。oVolume expansion with 10-20 ml/kg 0.9% saline should be used as first-line treatment of hypotension if myocardial dysfunction has been excluded (D).o已排除心功能不全引起的低血压，首选使用生理盐水10-20 ml/kg 扩容。oDopamine (2-20 g/kg/min) should be used if volume expansion fails to satisfactorily improve blood pressure
33、 (B).o多巴胺(2-20 g/kg/min) 在扩容后未能改善血压使用。oDobutamine (5-20 g/kg/min), as a first line, and epinephrine (0.01-1.0 g/kg/min) as a second line, should be used if low systemic blood flow and myocardial dysfunction need to be treated (D).o当有效血容量不足和心功能不全时，使用多巴酚丁胺(5-20 g/kg/min)（一线）, 肾上腺素(0.01-1.0 g/kg/min) （
34、二线）治疗。oHydrocortisone (1 mg/kg 8 hourly) should be used in cased of refractory hypotension where conventional therapy has failed (B).o难治性低血压可使用氢化可的松(1 mg/kg 每八小时一次) 治疗。oEchocardiographic examination may help to make decisions about when to start treatment for hypotension and what treatment to use (B
35、).o心脏彩超对于决定何时低血压、如何治疗低血压有帮助。oIf a decision is made to attempt therapeutic closure of the PDA, then indomethacin or ibuprofen have been shown to be equally efficacious (B).o消炎痛及布诺芬在治疗动脉导管未闭等效。oPharmacological or surgical treatment of presymptomatic or symptomatic PDA must be based on individual asses
36、sment of clinical signs and echocardiographic findings suggesting poor tolerance of PDA (D).o有/无症状的动脉导管未闭的药物性或手术治疗需根据临床症状及心脏超声提示是否为难耐受性动脉导管未闭作出个体化判断。Miscellaneous其他oElective caesarean section in low-risk pregnancies should not be performed before 39 weeks gestation (B).o不应实施孕39周前低高危因素的选择性剖宫产。oInhale
37、d nitric oxide therapy is not beneficial in management of preterm babies with RDS (A).o一氧化氮吸入对于治疗早产新生儿呼吸窘迫综合症无益处。oSurfactant therapy can be used to improve oxygenation following pulmonary haemorrhage (C).o肺表面活性物质的使用增加氧合，也增加肺出血。oSurafctant replacement for evolving BPD leads to only short-term benefits and cannot be recommended (C).o肺表替代治疗慢肺只有短期的疗效而不被推荐。
