Summary of Recommendations

Document Overview

Design and created by Guideline Central in participation with the Consensus and Physician Experts.

Management of Respiratory Distress Syndrome – 2025

Consensus and Physician Experts

Publication Date: Mar 9, 2026

Page Last Updated: May 5, 2026

CPE Grading System

Strength of Recommendation
S - Strong	Clear desirable or undesirable effects
W - Weak	Desirable and undesirable effects closely balanced or uncertain
GPR	Good practice recommendation
Quality of Evidence
H - High	Consistent evidence from well-performed RCTs or exceptionally strong evidence from unbiased observational studies
M - Moderate	Evidence from RCTs with important limitations or moderately strong evidence from unbiased observational studies
L - Low	Evidence for ≥1 critical outcome from observational studies, from RCTs with serious flaws or from indirect evidence
VL - Very Low	Evidence for ≥1 critical outcome from unsystematic clinical observations or very indirect evidence

Full Text Guideline: karger.com/neo/article/doi/10.1159/000551062/945992/European-Consensus-Guidelines-on-the-Management-of

Source Citation: Sweet DG, Carnielli VP, Greisen G, Hallman M, Klebermass-Schrehof K, Lavizzari A, Ozek E, Te Pas A, Roehr CC, Saugstad OD, Simeoni U, Vento M, Visser GHA, Speer CP. European Consensus Guidelines on the Management of Respiratory Distress Syndrome - 2025. Neonatology. 2026 Mar 9:1-40. doi: 10.1159/000551062. Epub ahead of print. PMID: 41802129.

Document Objectives: Every year new evidence emerges about how best to care for tiny babies with respiratory distress. We report the seventh version of “European Guidelines for the Management of RDS” by a panel of European neonatologists and an expert perinatal obstetrician based on available literature up to mid-2025. Optimising outcome involves close collaboration with obstetricians to predict risk of preterm delivery, consideration of transfer to perinatal centres and perinatal optimisation including antenatal steroids. Delivery room protocols should include maintenance of normal body temperature whilst aiming to promote spontaneous breathing before clamping the umbilical cord, using non-invasive respiratory support where possible and considering early use of surfactant delivered by thin catheter in an attempt to avoid intubation. Ongoing noninvasive respiratory support and judicious use of surfactant using techniques that avoid intubation will help improve outcomes. If mechanical ventilation is needed, lung protective strategies should be employed and ventilation continued for the shortest time possible to reduce risk of bronchopulmonary dysplasia. Protocols for general supportive care are also reviewed, with an emphasis on good nutritional care, cardiovascular support and judicious use of antibiotics.

Diseases/Conditions (MeSH)

D007231 - Infant, Newborn

D007234 - Infant, Premature

D058109 - Airway Management

D012127 - Respiratory Distress Syndrome, Newborn

D045422 - Continuous Positive Airway Pressure

D062071 - Infant, Extremely Premature

Keywords: Surfactant therapy, Thermoregulation , antenatal corticosteroids, continuous positive airway pressure (CPAP), mechanical ventilation, respiratory distress syndrome (RDS)

Level of Evidence
I	Evidence from ≥ 1 properly randomized, controlled trial.
II	Evidence from ≥ 1 well-designed clinical trial, without randomization; from cohort or case-controlled analytic studies (preferably from > 1 center); from multiple time-series; or from dramatic results of uncontrolled experiments.
III	Evidence from opinions of respected authorities, based on clinical experience, descriptive studies, or reports of expert committees.