Respiratory Distress Syndrome

Question 1

Respiratory Distress Syndrome Pathogenesis

Answer 1

• Surfactant produced by type 2 pneumocytes
• Lowers surface tension
• Inadequate surfactant causes air sacs to collapse
• Interstitial oedema, hypoxia, carbon dioxide retention
• Intrapulmonary or extra pulmonary right to left shunting

Question 2

Respiratory Distress Syndrome Secondary Causes

Answer 2

• Can be caused by pulmonary infection
• Intrapartum asphyxia
• Pulmonary haemorrhage…

Question 3

Respiratory Distress Syndrome Presentation

Answer 3

• Usually preterm delivery
• Respiratory distress after birth
• Tachypnoea, expiratory grunting, retractions, nasal flaring, cyanosis
• May rapidly progress to fatigue, apnoea and hypoxia

Question 4

Respiratory Distress Syndrome Differentials

Answer 4

• Pulmonary air leaks e.g. pneumothorax may occur from positive pressure ventilation or may be spontaneous
• Infection
• Pneumonia of due to GBS often coexists
• Aspiration of meconium or amniotic fluid ..

Question 5

Respiratory Distress Syndrome Ix

Answer 5

• Blood gases, respiratory and metabolic acidosis with hypoxia, MA from poor tissue perfusion
• Obs
• CXR
• FBC, U/Es, LFTs, glucose
• Echo for patent DA, shunting and exclusion
• Cultures to rule out sepsis

Question 6

Respiratory Distress Syndrome

Answer 6

Surfactant replacement therapy
-Given via endotracheal tube
-Oxygen (maintain between 91 and 95)
IPPV
Supportive therapy
-Gentle and minimal handling 
-Temperature regulation
-Fluids, metabolism and nutrition 
-Antibiotics after blood cultures for all infants with IRDS

Question 7

Respiratory Distress Syndrome Complications

Answer 7

• Trauma from intubation e.g. vocal cord damage
• Alveolar rupture
• PDA
• Persistent pulmonary hypertension
• Hospital acquired infection
• Necrotising enterocolitis
• Chronic complications e.g. retinopathy, lung disease, neurological impairment

Question 8

Respiratory Distress Syndrome Prevention

Answer 8

• Antenatal corticosteroids
• Delaying birth (tocolytics)
• Avoid hypothermia in neonate