Respiratory Distress Syndrome (Neonates)
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.
