European Consensus Guidelines on the Management of Respiratory Distress Syndrome: 2025

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 while aiming to promote spontaneous breathing before clamping the umbilical cord, using non-invasive respiratory support (NRS) where possible, and considering early use of surfactant delivered by a thin catheter in an attempt to avoid intubation. Ongoing NRS 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.