Respiratory distress syndrome

Question 1

What is respiratory distress syndrome?

Answer 1

Respiratory distress syndrome affects premature neonates, born before the lungs start producing adequate surfactant. Respiratory distress syndrome commonly occurs below 32 weeks. Chest xray shows a “ground-glass” appearance.

Question 2

Pathophysiology of RDS?

Answer 2

Inadequate surfactant leads to high surface tension within alveoli. This leads to atelectasis (lung collapse), as it is more difficult for the alveoli and the lungs to expand. This leads to inadequate gaseous exchange, resulting in hypoxia, hypercapnia (high CO2) and respiratory distress.

Question 3

Management of RDS?

Answer 3

Antenatal steroids (i.e. dexamethasone) given to mothers with suspected or confirmed preterm labour increases the production of surfactant and reduces the incidence and severity of respiratory distress syndrome in the baby.

Premature neonates may need:

Intubation and ventilation to fully assist breathing if the respiratory distress is severe
Endotracheal surfactant, which is artificial surfactant delivered into the lungs via an endotracheal tube
Continuous positive airway pressure (CPAP) via a nasal mask to help keep the lungs inflated whilst breathing
Supplementary oxygen to maintain oxygen saturations between 91 and 95% in preterm neonates

Support with breathing is gradually stepped down as the baby develops and is able to maintain their breathing, until they can support themselves in air.

Question 4

Short and long term complications of RDS?

Answer 4

Short term complications:

Pneumothorax
Infection
Apnoea
Intraventricular haemorrhage
Pulmonary haemorrhage
Necrotising enterocolitis

Long term complications:

Chronic lung disease of prematurity
Retinopathy of prematurity occurs more often and more severely in neonates with RDS
Neurological, hearing and visual impairment