Respiratory Distress Syndrome (N)

Question 1

What is RDS?

Answer 1

Surfactant deficiency 🡪 alveolar collapse and inadequate gas exchange
Excreted by type 2 pneumocytes. Mixture of proteins and lipids
Common <28 weeks. Less common in >34 weeks (surfactant produced to full amount by 34 weeks)

Question 2

What are risk factors for RDS?

Answer 2

• Prematurity (common in <28 weeks)
• At term if diabetic mother
• 2nd twin
• No antenatal corticosteroids before delivery
• Previous sibling with RDS
• Genetic mutation in surfactant
• C-section
• Birth asphyxia
• Male > girls
• Sepsis

Question 3

What are the signs and symptoms of RDS?

Answer 3

• RR >60/min
• Laboured breathing, recession (subcostal and sternal)
• Nasal flaring
• Expiratory grunting to create PEEP
• Cyanosis if severe
• CXR - Diffuse granular “ground glass’, air bronchogram, indistinct heart borders, pneumothoraces

Question 4

How is RDS managed?

Answer 4

• Antenatal GC (preterm anticipated <34 weeks) 🡪 reduce RDS, BPD, IVH
• Oxygen (careful of hyperoxia, start with 21-30% O2 or air if term infant. pO2 <95% and >91%)
• exogenous surfactant (via ET tube or catheter), ventilatory support (CPAP, high flow nasal cannula, intubation)
• Close monitoring for complications e.g.
  pneumothorax, retinopathy of prematurity

Question 5

What are some complications of RDS?

Answer 5

• Respiratory failure and death <48hrs
• Pneumonia, emphysema, pneumothorax (due to air leaks)
• Pulmonary or cerebral haemorrhage
• BPD (ventilation 🡪 scarring)