Despite recent advances in the perinatal management of neonatal respiratory distress syndrome controversies still exist. The aim of updated recommendations is to unite and start to use optimal therapeutic procedures, and to improve quality of care of preterm infants. The present study demonstrates that after the introduction of the European recommendations on the management of neonatal respiratory distress syndrome in preterm infants, clinical outcome of these newborns significantly improved over a decade resulting in a reduction of mortality and morbidity.

Several obstetric and neonatal procedures used in the management of children weighing 501–1,500 g changed in the years 2000–2009. In particular, a wider use of less invasive approach to ventilation has become more common (Soll et al. 2013). Early use of nCPAP led to decreased oxygen demand during the first 10 min, reduced a need for intubation, and shortened the time on mechanical ventilation and hospitalization. Moreover, quality of care of very immature children improved at the delivery room. However, a question of how to achieve a full implementation of the European guidelines on the management of respiratory distress syndrome in all hospitals and workplaces remains open.