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Respiratory distress syndrome (Risk factors (Perinatal hypoxia, Meconium…
Respiratory distress
syndrome
Definition
Lung disease caused by
a deficiency in surfactant
Epidemiology
Preterms (<32w)
Pathophysiology
Lack of surfactant causes reduced
surface tension on the alveoli
Alveoli collapse on expiration, greater
force and energy needed to open them
on subsequent inspiration
Increased work of breathing and hypoxia
Intrapulmonary shunting of blood to
better ventilated areas
Occurs <4h birth, worsens 48-72h (if untx), resolves 5-7d
Risk factors
Perinatal hypoxia
Meconium aspiration
Hypothermia
CS delivery
Maternal DM
FH
Congenital pneumonia
Clinical
presentation
Cyanosis
Tachypnoea
Grunting
Intercostal recession
Diagnosis
Examination
Neonatal examination
Distress (nasal flaring, intercostal recession,
high RR, cyanosis, grunting)
Investigations
Bedside
Obs (sats, RR, HR, BP, temp)
Bloods
ABG (O2, acid-base)
Imaging
CXR: bilateral, diffuse, ground glass (atelectasis).
airway bronchograms, reduced lung vol
History
PMH
Respiratory conditions
other chronic conditions
POH
Gravity/parity, gestation, delivery,
previous RDS/other complications
Current pregnancy
Gestation, scans/bloods,
any problems, delivery
PC/HPC
Onset, character, associated symptoms,
timing, exacerbating/relieving, severity
DH
Medications, allergies
FH
Respiratory conditions
Neonatal RDS
SH
Smoking, alcohol
Management
Medical
Respiratory support
Indication: respiratory distress
E.g. high flow O2, CPAP, intubation
Surfactant
Indication: extreme preterm
E.g. survanta, curosurf
MOA: requires intubation and ventilation; given as bolus down ETT, 2nd dose if needed
Abx
Indication: ASAP until congenital pneumonia excluded
E.g. penicillin and gentamycin
IV fluids
Indication: ASAP until stable
E.g. Hartmann's
Feeding
Indication: until stable
MOA: NG if stable, parenteral if unstable
Conservative
Delivery room resus
Prognosis
Good for most
Mortality 5-10%
Bronchopulmonary dysplasia 15%
Prevention
Steroids
Given 1-7d before birth to improve lung maturity
Treat co-morbidities
E.g. infection, acidosis, hypothermia
All affect surfactant development
