Resp - Respiratory Distress Syndrome

Question 1

Definition

Answer 1

Affects premature neonates, before the lungs start producing adequate surfactant,
common in below 32 week babies.

Question 2

Pathophysiology

Answer 2

Inadequate surfactant leads to high surface tension within alveoli leading to atelectasis (lung collapse) as it is more difficult for the alveoli and the lungs to expand leading to inadequate gaseous exchange and hypoxia, hypercapnia and respiratory distress.

Question 3

Signs + symptoms

Answer 3

Signs:
- Cyanosis (due to low oxygen saturation)
- Tachypnoea
- Raised respiratory rate
- Use of accessory muscles of breathing, such as the sternocleidomastoid, abdominal and intercostal muscles
Intercostal and subcostal recessions
- Tracheal tugging
- Hypoxia

Symptoms:
- Grunting
- Restlessness
- Nasal flaring
- Head bobbing

Abnormal airway noises

Question 4

Diagnosis

Answer 4

CXR:
- diffuse, granular or ground glass appearance of the lungs with air bronchograms.

Question 5

Treatment

Answer 5

Antenatal maternal glucocorticoid administration: in the event of premature labour, delivering steroids and delaying labour by 24h can help promote surfactant production
Raised ambient oxygen: 21-30% FiO2 is the usual starting oxygen;
- sats >95% should be avoided as it can cause prematurity of retinopathy;
- sats <91% can contribute to necrotising enterocolitis
Surfactant therapy: artifical surfactant is delivered via a tracheal tube or catheter
Mechanical ventilation

Question 6

Complications

Answer 6

Short Term
- Pneumothorax
- Infection
- Apnoea
- Intraventricular haemorrhage
- Pulmonary haemorrhage
- Necrotising Enterocolitis

Long Term
- Chronic lung disease of prematurity
- Retinopathy of prematurity
- Neurological, hearing and visual impairment