Makindo Medical Notes

Related Subjects:Sick Neonate |APGAR Scoring |Approach to Assessing Sick Child |Sick Child with Acute Gastroenteritis |Sick Child with Respiratory DistressAsthma |Acute Severe Asthma |Respiratory Failure

⚠️ Main cause of death in premature babies.

📖 About

• 👶 Respiratory Distress Syndrome (RDS) is a major cause of morbidity and mortality in premature infants.
• ⚡ It is the leading cause of death in premature babies, especially those <32 weeks.
• 🫁 Also called Hyaline Membrane Disease due to the classic formation of hyaline membranes in alveoli.

🧬 Aetiology

• ❌ Caused by surfactant deficiency → ↑ surface tension → alveolar collapse.
• 👶 <28 weeks = highest risk due to immature lungs.
• 📊 Incidence: ~100% at 24–28 weeks → ~50% at 32 weeks.

🩺 Clinical Presentation

• Signs: 🚼 Tachypnoea, severe respiratory distress, cyanosis.
• Exam: 🫁 Intercostal & subcostal retractions, 👃 nasal flaring, 🗣️ grunting (auto-PEEP to keep alveoli open).

🔍 Differentials

• TTN: 🌊 Transient tachypnoea of the newborn – delayed lung fluid clearance, esp. C-sections.
• MAS: 💩 Meconium aspiration syndrome – term/post-term infants inhaling meconium-stained fluid.

🧪 Investigations

• 🩸 ABG: Type 1 respiratory failure (hypoxemia without hypercapnia).
• 📸 CXR: “Ground-glass” granular appearance + air bronchograms + low lung volumes.

💊 Management

• Prevention: 🤰 Antenatal corticosteroids (24–34 wks) to boost surfactant production. ⚠️ Side effects: ↑ glucose, GI bleeding, intestinal perforation.
• Supportive Care:
  • ❤️ ABCs: Stabilise airway, breathing, circulation.
  • 🫁 Oxygen → target saturations (avoid hyperoxia).
  • 🚨 ET intubation + early exogenous surfactant for severe cases.
  • 💨 CPAP: Keeps alveoli open, reduces work of breathing.
• Additional Care:
  • 💧 Careful fluid/electrolyte balance (avoid pulmonary oedema).
  • 🍼 Trophic feeding + gradual enteral nutrition → growth support.
  • 🦠 Prophylactic fluconazole in very low birth weight infants.
• Palliative Care: 🕊️ For infants with poor prognosis or extreme prematurity.

💡 Teaching Pearls

• 📌 Surfactant is produced by type II pneumocytes from 24 weeks, adequate after 34 weeks.
• 👂 Grunting in neonates = an attempt to keep alveoli open (auto-PEEP).
• 📊 Risk is inversely proportional to gestational age.
• ⚠️ Always differentiate RDS from TTN & MAS in exams (key OSCE question!).

📚 References

• UpToDate: Respiratory distress syndrome in the newborn.
• RCOG Green-top Guidelines: Antenatal corticosteroids.
• Neonatology Textbook, 8th Edition.