We searched the authors' personal files and references, PubMed, and Google Scholar for the terms (“infant, newborn”[MeSH Terms] OR (“infant”[All Fields] AND “newborn”[All Fields]) OR “newborn infant”[All Fields] OR “neonate”[All Fields]) AND “ARDS”[All Fields] OR “acute respiratory distress syndrome” or “acute lung injury”[All Fields]), with no restriction on language or date. This search was last done on Sept 12, 2016. We also searched the Pediatric Academic Societies meetings' abstracts'
Position PaperThe Montreux definition of neonatal ARDS: biological and clinical background behind the description of a new entity
Introduction
Acute respiratory distress syndrome (ARDS) is undefined in neonates, despite the longstanding recognition of ARDS in later life. We describe the Neonatal ARDS Project: an international, collaborative, multicentre, and multidisciplinary project which aimed to produce an ARDS consensus definition for neonates that is applicable from the perinatal period. This project is an initiative endorsed by the European Society for Pediatric and Neonatal Intensive Care (ESPNIC) and the European Society for Pediatric Research (ESPR). The Steering Committee of the Neonatal ARDS Project first reviewed the literature on the biological, pathophysiological, and histological features of ARDS in neonates compared with other age groups, and on the current definitions of ARDS in older children and adults. The consensus definition was then developed from this literature analysis. This paper also presents the rationale for issuing a specific definition of ARDS in neonates.
Section snippets
Age and evolution of the ARDS definition
ARDS was originally reported in 12 patients (including an 11-year-old) by Ashbaugh and colleagues1 in The Lancet in 1967. They characterised ARDS as “dyspnoea, tachypnoea, cyanosis resistant to oxygen therapy, loss of lung compliance, and diffuse alveolar infiltration” and “areas of atelectasis, alveolar oedema, and haemorrhage” at necropsy. The clinical and histological similarities with respiratory distress syndrome (RDS) in neonates due to primary surfactant deficiency2, 3 were recognised
Why do we need a definition of neonatal ARDS?
The first month of life (ie, the neonatal period) is a unique life-stage characterised by a high risk of mortality.19 The American Academy of Pediatrics recommends that causes of mortality would be specifically defined for the first month of life and include perinatal events and the degree of fetal maturation.20 The PALICC definition17 specifically excludes causes of acute hypoxaemia that are unique to the perinatal period. Primary RDS related to prematurity is clearly different from paediatric
Does neonatal ARDS really exist?
From our search strategy we retrieved 32 publications that used the term neonatal ARDS: 23 clinical (mainly case series) and nine translational neonatal animal model studies (see appendix). The first use of the term neonatal ARDS in 1989 described 11 term neonates with ARDS associated with perinatal asphyxia and meconium or blood aspiration.28 Faix and colleagues28 concluded that “ARDS can and does occur in newborn infants. We see no reason why this syndrome could not be superimposed on some of
Biological, pathophysiological, and histological rationale for neonatal ARDS
ARDS is biologically characterised by qualitative or quantitative surfactant dysfunction affecting both proteins and phospholipids, and extensive lung tissue inflammation.31, 32 These biological processes share commonality with a number of neonatal respiratory disorders characterised by variable secondary impairment of surfactant function or surfactant amount, rather than primary surfactant deficiency. For instance, meconium aspiration syndrome, biliary pneumonia, and respiratory failure
Methods used in the Neonatal ARDS Project
An international multidisciplinary collaborative project commenced in January, 2014, with the aim to draft and test a definition for neonatal ARDS. The project method is summarised in figure 3. Experts in respiratory critical care from neonatal and paediatric intensive care units representing ESPNIC, ESPR, and independent expert colleagues, were contacted to create a Steering Committee composed of 12 members. Experts were selected after discussion in ESPNIC and ESPR Councils, on the basis of
The Montreux definition of neonatal ARDS
The Committee maintained consistency in ARDS12 and paediatric ARDS17 definitions where possible. Table 2 shows the final Montreux definition of neonatal ARDS, which was approved by consensus of the Steering Committee at a meeting in Montreux (Switzerland). The following ten points addressed in this Committee meeting should be highlighted. First, the definition of neonatal ARDS applies to infants from birth until 44 weeks, post-menstrual age or until 4 weeks, postnatal age (for neonates born
Next steps
The Neonatal ARDS Project is divided into two main phases (figure 3). The first phase aimed to review the available literature to create a definition of neonatal ARDS based on an expert consensus of the available scientific knowledge: this phase led to the Montreux definition. This definition has now been or is being presented at ESPNIC, ESPR, and local congresses in order to identify health-care professionals from neonatal and paediatric intensive care units who are willing to participate in
Conclusions
With the dissemination of the Montreux definition of neonatal ARDS, we expect an increase in the clinical attention to the entity of the disorder. The Montreux definition might foster neonatal ARDS research, which will facilitate the investigation of new therapeutic approaches, such as larger or multiple dosing of exogenous surfactants and anti-inflammatory or surfactant protective agents.93, 94 The knowledge that will be acquired in this area might also be useful in the clinical care and
Search strategy and selection criteria
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