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Updated: May 18 2022

Respiratory Distress Syndrome

  • Snapshot
    • A infant presents with signs of respiratory distress within minutes of birth. He was born at 28 weeks gestation to a diabetic mother. Vital signs are significant for a respiratory rate of 72/min. Nasal flaring and intercostal retractions are noted on exam. A diffuse ground glass appearance, as well as air bronchogram is seen on radiography.
  • Introduction
    • Most common form of respiratory failure in preterm infants
    • Results from surfactant deficiency
      • causing decreased lung compliance and atelactasis
    • Incidence
      • Observed in 65% of preterm infants born at 28-30 weeks of gestation
    • Risk factors include:
      • maternal diabetes 
      • males > females
      • second born of twins
  • Presentation
    • Symptoms
      • usually presents at birth, or immediately after birth, with symptoms including:
        • cyanosis
        • tachypnea
        • nasal flaring
        • grunting
    • Physical exam
      • respiratory rate > 60/min
      • hypoxemia
      • intercostal retractions
      • expiratory grunting
  • imaging
    • CXR
      • shows bilateral atelectasis
      • air bronchogram
      • classic "ground glass" appearance
  • Differential
    • Transient tachypnea of newborn
      • CXR shows prominant perihilar streaking in the interlobular fissures
      • due to retained amniotic fluids
    • Meconium aspiration syndrome
      • CXR findings include coarse, irregular infiltrates and hyperexpansion
    • Congenital pneumonia
      • CXR not useful
      • diagnosis based on neutropenia and tracheal aspirate with Gram stain
    • Others potential pathology includes spontaneous pneumothorax, diaphragmatic hernia, and cyanotic heart disease
  • diagnosis
    • Diagnosis primarily based on history, clinical presentation, and radiography
      • gestational age
      • maternal risk factors
        • e.g., diabetes
      • mode of delivery
        • e.g., cesarean section
  • Treatment
    • Prevention
      • monitor lecithin/sphingmyelin ratio and phosphotidylglycol
      • pretreat mothers at high risk of preterm birth (34 weeks gestation or less) with corticosteroids (betamethasone)
    • Medical management
      • intubation/CPAP/mechanical ventilation
        • indicated to maintain adequate oxygenation
      • surfactant replacement
        • indicated to increase lung compliance, reducing atelectasis
        • shown to decrease mortality
      • supportive care
        • most patients remain hospitalized in the NICU for several days/weeks
  • Complications
    • Persistant PDA, bronchopulmonary dysplasia, retinopathy of prematurity secondary to oxygen supplementation, intraventricular hemorrhage, and necrotizing enterocolitis
  • Prognosis
    • Ranges widely depending on degree of prematurity and lung development
    • Immediate, intensive care critical for survival in diagnosed cases
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