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Infant Respiratory Distress Syndrom (IRDS) (Signs of respiratory distress,…
Infant Respiratory Distress Syndrom (IRDS)
A.K.A HYALINE MEMBRANE DISEASE
Lungs have not completely developed and infant lacks sufficient quantities of pulmonary surfactant
Lack of normal surfactant INCREASES surface tension, making the alveoli prone to collapse
Atelectasis occurs, causing shunting and severe hypoxemia that does NOT respond to O2 therapy
Hypoxemia causes vasoconstriction and hypertension
Decreases lung compliance and increases WOB
Indicators for pulmonary prematurity
L/S (lecithin/sphingomyelin) ratio < 2
Phosphatidyl glycerol
Signs of respiratory distress
Tachypnea > 60 breaths per minute
Subcostal and intercostal retractions
Expiratory grunting
Decreases breath sounds
Nasal flaring
Cyanosis on RA
Recommend
Chest X-ray
Diffuse reticulogranular ("ground-glass") appearance
Air bronchograms
ABG
Respiratory acidosis with severe hypoxemia
Echocardiogram if extra pulmonary shunting is expected
Differential diagnosis
Transient tachypnea of the newborn (TTN)
Rule out infectious causes such as Streptococcal pneumonia or sepsis
Hyperoxia test to rule out critical congenital heart defect (CCHD)
Treatment
Woman at high-risk of giving birth 24-34 weeks
Corticosteroids to enhance lung maturity and reduce risk of RDS, brain hemorrhage or death
Prophylactic surfactant therapy
Intubate-surfactant-extubate
Immediately place on nasal CPAP 4-6 cmH20
High-flow nasal cannula 1-6 L/min
Incubator or radiant warmer
Fi02 to maintain Pa02 50-70 mmHg and Sp02 85-92%
Intubate and MV
Infant < 27 weeks and mother did not receive steroids
Infant is apneic
Unable to maintain adequate airway
Exhibits increases WOB on CPAP
Cannot maintain pH > 7.25 on CPAP
Permissive hypercapnia
VT 4-5 mL/kg
PaC02 rise as long as pH > 7.20