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CME: Revenge of the nRDS: taking the fight to neonatal respiratory distress syndrome with optimized CPAP, lung ultrasound, and less invasive surfactant care

Activity Description / Statement of Need:

In this online, self-learning activity:

Neonatal respiratory distress syndrome (nRDS) remains a leading cause of respiratory failure and morbidity among preterm infants worldwide, despite major advances in antenatal steroids, continuous positive airway pressure (CPAP), and surfactant therapy. Contemporary guidelines emphasize early noninvasive respiratory support from birth, selective surfactant rescue once CPAP begins to fail, and structured, protocolized care across gestational age strata. Yet practice-pattern studies across high- and middle-income settings show wide variation in initial respiratory support, surfactant thresholds, and use of minimally invasive techniques, with extremely preterm and late preterm infants often receiving care that diverges from guideline-concordant pathways. These inconsistencies increase cumulative ventilator exposure and risk of bronchopulmonary dysplasia (BPD) and other complications, underscoring a persistent implementation gap between best evidence and routine NICU care.

Target Audience:

The following HCPs: neonatologists; physician assistants, nurse practitioners, nurses, and pharmacists who practice in neonatology; and any other healthcare professionals with an interest in or who clinically encounter patients with neonatal respiratory distress syndrome (nRDS).

Commercial Support Disclosure: This program is supported by an educational grant from Chiesi USA, Inc.

This activity is free of charge.

Release Date: May 27, 2026 -- Expiration Date: May 27, 2028

Faculty: Meena Garg, MD

Agenda

Faculty introduction, disclosures

Introductory content: review of neonatal respiratory distress syndrome (nRDS)

  • Epidemiology of nRDS by gestational age (extremely preterm, very preterm, late preterm) and setting (high- vs middle-income)
  • Pathophysiology and clinical presentation: surfactant deficiency, reduced compliance, and evolving lung injury
  • Overview of guideline-recommended CPAP-first and selective surfactant strategies
  • Early identification challenges in extremely preterm and late preterm infants (subtle signs, comorbidities, delivery-room constraints)

nRDS management

  • Early identification and prediction of CPAP failure 
    • Defining CPAP failure: incidence, risk factors, and impact on short- and long-term outcomes
    • Use of FiO₂ trajectories, gestational age, and standardized prediction tools to anticipate CPAP failure
    • Integration of LUS scoring into bedside decision-making
    • Developing unit-specific thresholds and pathways for early rescue surfactant
  • Surfactant therapy and respiratory support strategies 
    • Comparison of LISA/MIST, INSURE, and traditional intubation for surfactant delivery (evidence review)
    • Practical aspects of LISA: patient selection, timing, procedural steps, and team roles
    • Evidence-based surfactant dosing and re-dosing (e.g., high-dose surfactant) and implications for extremely preterm versus late preterm infants
    • Sedation and analgesia during LISA: current evidence, risks/benefits, and practice variation
    • Aligning respiratory support modalities (CPAP, NIV, HFNC) with gestational age and disease trajectory within protocolized nRDS pathways
  • Patient case(s)

Summary, conclusions, and best practice recap

Learning Objectives

By the end of the session the participant will be able to:

  • Describe current guideline-based and evidence-based strategies for early identification and management of neonatal respiratory distress syndrome (nRDS) across gestational age subgroups.
  • Discuss how LUS and clinical predictors (including FiO₂ thresholds and CPAP-failure tools) identify infants at high risk for CPAP failure and timely surfactant need.
  • Recall surfactant administration methods (LISA/MIST, INSURE, traditional intubation) and dosing strategies, and select minimally invasive, evidence-based approaches tailored to extremely preterm and late preterm infants.
  • Recall best practices in interdisciplinary nRDS care bundle and unit-level protocol development that to improve short- and long-term respiratory outcomes in preterm infant subgroups.

Accreditation

ACCME Activity #203701433

ScientiaCME is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.

Credit Designation: ScientiaCME designates this enduring material for a maximum of 1.0 AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

ABP MOC Recognition Statement: Successful completion of this CME activity, which includes participation in the evaluation component, enables the participant to earn up to 1.0 MOC points in the American Board of Pediatrics' (ABP) Maintenance of Certification (MOC) program. It is the CME activity provider's responsibility to submit participant completion information to ACCME for the purpose of granting ABP MOC credit.

ABP MOC Credit Type: Lifelong Learning and Self-Assessment

Physicians: For maintenance of certification (MOC) points, you must enter your board certification ID # and birth date correctly.  It is the learner's responsibility to provide this information completely and accurately at the completion of the activity. Without providing it, the learner will NOT receive MOC points for this activity. By providing this data, you acknowledge that it will be shared with ACCME and the applicable certifying board. Please note: Not all activities on this site provide MOC points. If this activity does not specify that it provides MOC points in this section, then it does NOT provide MOC points. This activity provides MOC points only for ABP.

Pharmacists

ScientiaCME is accredited by the Accreditation Council for Pharmacy Education (ACPE) as a provider of continuing pharmacy education. This activity is approved for 1.0 contact hours (0.1 CEUs) of continuing pharmacy education credit. Proof of participation will be posted to your NABP CPE profile within 4 to 6 weeks to participants who have successfully completed the post-test. Participants must participate in the entire presentation and complete the course evaluation to receive continuing pharmacy education credit. ACPE #0574-0000-26-027-H01-P. This is an Application (A) type activity. 

Pharmacists: You must enter your NABP # and birth date correctly so that proof of participation can be posted to your NABP CPE profile. It is the learner's responsibility to provide this information completely and accurately at the completion of the activity. Without providing it, the learner will NOT receive CPE credit for this activity.

Nurses: The American Nurses Credentialing Center (ANCC) accepts AMA PRA Category 1 Credit(s)™ from organizations accredited by the ACCME. This activity is designated for up to 1.0 AMA PRA Category 1 Credit(s)™.

Physician Assistants: The American Academy of Physician Assistants (AAPA) accepts AMA PRA Category 1 Credit™ assigned by organizations accredited by the ACCME as satisfying Category 1 CME for National Commission on Certification of Physician Assistants (NCCPA) national certification maintenance. This activity is designated for up to 1.0 AMA PRA Category 1 Credit(s)™.

Nurse Practitioners: The American Academy of Nurse Practitioners Certification Board (AANPCB) states that continuing education providers accredited by the ACCME may provide acceptable, accredited Advanced Practice Provider content. This activity is designated for up to 1.0 AMA PRA Category 1 Credit(s)™.


Faculty Disclosure and Resolution of COI

As a provider of continuing medical education, it is the policy of ScientiaCME to ensure balance, independence, objectivity, and scientific rigor in all of its educational activities. In accordance with this policy, faculty and educational planners must disclose any significant relationships with commercial interests whose products or devices may be mentioned in faculty presentations, and any relationships with the commercial supporter of the activity. The intent of this disclosure is to provide the intended audience with information on which they can make their own judgments. Additionally, in the event a conflict of interest (COI) does exist, it is the policy of ScientiaCME to ensure that the COI is resolved in order to ensure the integrity of the CME activity. For this CME activity, any COI has been resolved thru content review by ScientiaCME.

Disclosure of Faculty: Meena Garg, MD, Professor of Clinical Pediatrics, UCLA School of Medicine, has no relevant financial disclosures.

Disclosures of Educational Planners: Charles Turck, PharmD, BCPS, BCCCP, President of ScientiaCME, has no relevant financial disclosures.

Faculty will NOT discuss off-label uses.

All relevant financial relationships have been mitigated.

ScientiaCME adheres to the ACCME’s Standards for Integrity and Independence in Accredited Continuing Education. Any individuals in a position to control the content of a CE activity, including faculty, planners, reviewers or others are required to disclose all relevant financial relationships with ineligible entities (commercial interests). All relevant conflicts of interest have been mitigated prior to the commencement of the activity.

Commercial Support Disclosure: This program is supported by an educational grant from Chiesi USA, Inc.

Instructions

  • Read the learning objectives above
  • Take the Pre-Test (optional). Completion of the pre-test will help us evaluate the knowledge gained by participating in this CME activity.
  • View the online activity. You may view this is in more than one session, and may pause or repeat any portion of the presentation if you need to.
  • Minimum participation threshold: Take the post-test. A score of 70% or higher is required to pass and proceed to the activity evaluation.
  • Complete the activity evaluation and CME registration. A CE certificate will be emailed to you immediately.

Cultural/Linguistic Competence & Health Disparities

System Requirements

PC
Windows 7 or above
Internet Explorer 8
*Adobe Acrobat Reader
MAC
Mac OS 10.2.8
Safari or Chrome or Firefox
*Adobe Acrobat Reader
Internet Explorer is not supported on the Macintosh

*Required to view Printable PDF Version

Perform Pre-Test (optional)

Please take a few minutes to participate in the optional pre-test. It will help us measure the knowledge gained by participating in this activity.

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