Definition

Target saturations 93–97% at 36 weeks’ CGA (see Oxygen saturation targets guideline for details)

Investigations at time of assessment (see above)

• Blood gas
• Chest X-ray: homogenous opacification of lung fields developing after first week after birth or coarse streaky opacities with cystic translucencies in lung fields can be suggestive of CLD
• Echocardiography to rule out pulmonary hypertension or structural pathology 
• Electrocardiography to rule out pulmonary hypertension
• Overnight pulse oximetry study (see Oxygen on discharge guideline)

Optimise ventilation strategies

• Volume-targeted/volume-guarantee ventilation is preferred mode of ventilation in neonates 
  
  • if using pressure limited ventilation, use lowest possible ventilator pressures to deliver appropriate tidal volumes to minimise volutrauma/barotrauma [see Ventilation: volume-targeted (volume guarantee/targeted tidal volume) and Ventilation: synchronous positive pressure ventilation (SIPPV) guidelines]

Optimise nutrition

• Ensure adequate nutrient intake (120% of normal) because of increased work of breathing  
• If growth unsatisfactory, involve neonatal/paediatric dietitian (see Nutrition and enteral feeding guideline) 
• Avoid fluid overload

Corticosteroids

• If ventilator-dependent and requiring increasing or persistently high oxygen intake, consider using corticosteroids 
  
  • treatment with corticosteroids (dexamethasone/hydrocortisone) is a consultant decision
  • do not use dexamethasone with non-steroidal anti-inflammatory drugs
• Inform parents of potential short-term and long-term adverse effects 
• Obtain oral consent and record in notes

Short-term side effects of corticosteroids

• Risk of infection 

• Poor growth

• Reversible ventricular hypertrophy

• Gastrointestinal perforation and bleeding

• Adrenal suppression

• Glucose intolerance

Long-term side effects of corticosteroids

• Increased risk of neurodisability

Doses

• Use Neonatal Formulary for dexamethasone dosage regimen (consultant decision on DART versus Minidex^® regimen)
• If respiratory status worsens after initial improvement repeat course may be needed (consultant decision)

Monitoring while on corticosteroids

• Daily BP with urinary glucose

Diuretics

• Use of diuretics to improve lung function (consultant decision). Diuretics of choice are chlorothiazide and spironolactone (use of spironolactone can be guided by serum potassium).  Avoid amiloride due to its lung fluid retaining properties
• Side effects include hyponatraemia, hypo/hyperkalaemia, hypercalciuria (leading to nephrocalcinosis) and metabolic alkalosis 
• If no improvement on diuretics, stop after 1 week

Monitoring treatment

Continuous

• Aim for SpO₂ 91–95% until 36 weeks’ CGA
• After 36 weeks’ CGA, maintain SpO₂ 93–97% to prevent pulmonary hypertension 
• Warm and humidify supplemental oxygen unless on low-flow oxygen
• Monitor weight, length and head growth (see Growth monitoring guideline)
• Assess for gastro-oesophageal reflux [see Gastro-oesophageal reflux disease (GORD) guideline]
• Aim to stop diuretic therapy before discharge (consultant decision)

• If still oxygen-dependent at time of discharge (see Oxygen on discharge guideline)
• Long-term neurodevelopmental and respiratory follow-up