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Advances in the management of respiratory distress syndrome (RDS) ensure that clinicians must continue to revise current practice. We report the third update of the European Guidelines for the Management of RDS by a European panel of expert neonatologists including input from an expert perinatal obstetrician based on available literature up to the beginning of 2016. Optimizing the outcome for babies with RDS includes consideration of when to use antenatal steroids, and good obstetric practice includes methods of predicting the risk of preterm delivery and also consideration of whether transfer to a perinatal centre is necessary and safe. Methods for optimal delivery room management have become more evidence based, and protocols for lung protection, including initiation of continuous positive airway pressure and titration of oxygen, should be implemented from soon after birth. Surfactant replacement therapy is a crucial part of the management of RDS, and newer protocols for surfactant administration are aimed at avoiding exposure to mechanical ventilation, and there is more evidence of differences among various surfactants in clinical use. Newer methods of maintaining babies on non-invasive respiratory support have been developed and offer potential for greater comfort and less chronic lung disease. As technology for delivering mechanical ventilation improves, the risk of causing lung injury should decrease although minimizing the time spent on mechanical ventilation using caffeine and if necessary postnatal steroids are also important considerations. Protocols for optimizing the general care of infants with RDS are also essential with good temperature control, careful fluid and nutritional management, maintenance of perfusion and judicious use of antibiotics all being important determinants of best outcome. (C) 2016 S. Karger AG, Basel

Pranatale Infektion und die Chorioamnionitis sind wesentliche Risikofaktoren fur spontane, meist sehr fruhe Fruhgeburt. Die Chorioamnionitis tragt auf diese Weise signifikant zu Fruhgeburts-bedingter Morbiditat und Letalitat bei. Der Nachweis eines gestationsunabhangigen Effekts von Chorioamnionitis auf das Outcome sehr kleiner Fruhgeborener ist unter anderem durch das Fehlen einer Vergleichsgruppe „gesunder Fruhgeborener“ erschwert, da Fruhgeburtlichkeit, wenn nicht mit Inflammation, meist mit anderen pranatalen Pathologien asssoziiert ist. Die Fortschritte der letzten Jahren im perinatologischen und neonatologischen Management verwischen zudem die Assoziation zwischen pranataler Entzundung und Morbiditat und Letalitat dieser Hochrisiko-Kinder. Eine histologische Chorioamnionitis ist assoziiert mit einer geringeren Inzidenz und Schwere des Atemnotsyndroms. Kurzfristige Maturations-induzierende Prozesse sind aber mit einer erhohten Empfindlichkeit der unreifen Lunge fur postnatale Noxen, wie mechanischer Beatmung, verbunden und begunstigen somit das Auftreten der Bronchopulmonalen Dysplasie. Die Datenlage zur Bedeutung der Chorioamnionitis fur eine Hirnschadigung von sehr kleinen Fruhgeborenen ist inkonsistent, wenn auch Metaanalysen die Entzundung der fetoplazentaren Einheit mit einem erhohten Risiko fur die zystische periventrikulare Leukomalazie und die Cerebralparese in Verbindung bringen. Neueste epidemiologische Daten machen zudem eine Rolle der Chorioamnionitis in der Atiopathogenese der Fruhgeborenenretinopathie wahrscheinlich.

Surfactant proteins (SP) A and D play a key role in pulmonary host defense of preterm and term newborns. SP-A and SP-D have structural elements of both collagens and lectins, for which they are called "collectins". SP-A and SP-D coordinate the innate and adaptive immune response in the lung and convey protection against infection in amniotic fluid and vernix caseosa. They are pattern-recognizing molecules of the innate immune system that are involved in binding, agglutination of pathogens, chemotaxis of neutrophils, phagocytosis of pathogens, and production of reactive oxygen species. In addition, SP-A and SP-D interact with the adaptive immune system by reducing interleukin-2 production and T lymphocyte proliferation.

We report an 18-months-old boy with congenital spleen hypoplasia and cardiovascular defects. Besides, several minor clinical manifestations such as facial anomalies, hypospadia glans penis, agenesis of the corpus callosum and iris anomalies were observed. A partial or complete lateralisation defect could be excluded. The patient's phenotype comprises a previously undescribed combination of major and minor clinical features of the Ivemark syndrome. The case indicates that a common genetic defect might be the cause of this syndrome, which shows a variable expression.

In an international multicenter trial infants with clinical and radiological signs of severe RDS (age 2-15 h, birthweight 700-2,000 g, mechanical ventilation, FiO2 greater-than-or-equal-to 0.6, no complicating disease) were randomized to receive either a single dose (n = 176) or up to three subsequent doses (n = 167) of a natural porcine surfactant (Curosurf). Using a logistic regression model, the effects of therapy, birthweight, sex, hospital and other clinical factors on survival and various outcome parameters were evaluated. Mortality (13 vs. 21 %, p

There is now convincing evidence that the severity of neonatal respiratory distress syndrome can be reduced by surfactant replacement therapy; however, the optimal therapeutic regimen has not been defined. This randomized European multicenter trial was designed to determine whether the beneficial effects of a single large dose of Curosurf (200 mg/kg) in babies with severe respiratory distress syndrome (arterial to alveolar oxygen tension ratio approximately 0.10) could be enhanced by using multiple doses of surfactant. Preterm neonates (birth weight 700 to 2000 g) with severe respiratory distress syndrome requiring artificial ventilation with fraction of inspired oxygen greater-than-or-equal-to 0.6 were randomized into two groups at an age of 2 to 15 hours. Both groups received the usual dose of Curosurf (200 mg/kg) immediately after randomization. In neonates randomized to receive multiple-dose treatment, two additional doses of Curosurf (100 mg/kg each) were instilled into the airways (12 and 24 hours after the initial dose) provided that the patients still needed artificial ventilation with fraction of inspired oxygen > 0.21. In both groups (single dose: n = 176, multiple doses: n = 167) there was a rapid improvement in oxygenation as reflected by a threefold increase in arterial to alveolar oxygen tension ratio within 5 minutes after surfactant instillation (P

In neonatal and adult polymorphonuclear leukocytes (PMN) we determined the content and the release of beta-glucuronidase, myeloperoxidase, lysozyme and lactoferrin. We found an equal total content of these proteins in adult and neonatal PMN, except for a lower lysozyme concentration in neonatal PMN. In the presence of opsonized zymosan myeloperoxidase, lysozyme and beta-glucuronidase were released in equal amounts; lactoferrin, however, was released to a lower rate from neonatal than from adult PMN (p less than 0.0005).