James: Neonatal RDS case study

This case study reviews the neonatal journey of James and includes analysis of participation in the POLAR (positive end-expiratory pressure levels during resuscitation at birth) trial, comparing dynamic positive end-expiratory pressure (PEEP) (new intervention) to static PEEP (current standard of care); he received dynamic PEEP at delivery. James was born at 23 + 5 weeks gestation via spontaneous vaginal delivery. His mother received one dose of antenatal steroids and intravenous magnesium sulfate (MgSO₄). James weighed 628 g at birth. The pathophysiology, care provided, and ethical legal and professional issues are explored. The survival of preterm infants has increased, however, the prevalence of neonatal morbidities associated with premature birth such as BPD and neurodevelopmental impairment remains high. In James’ case, being part of a clinical trial has had no apparent negative consequences; At the time of writing this trial continues, potentially improving future PEEP management at delivery and the incidence of chronic lung in preterm neonates.