Objectives

1
Respiratory Distress Syndrome
Objectives
what is respiratory distress syndrome (HMD)? what
are the risk factors for RDS? describe the
pathophysiology of RDS and to correlates it with
the clinical features and lab. Tests what are
the clinical, radiological, laboratory features
of RDS? How can these help you to reach the
diagnosis How would you manage an infant with
RDS what are the complications of RDS? how can we
prevent RDS?
Overview of Presentation
Introduction Pathophysiology Clinical
features Management Complications Prevention
Introduction
RDS is the most frequent cause of respiratory
distress in premature infants Incidence is
inversely related to GA 60-80 of lt28wk GA 15-30
of 32-36wk GA 5 of term infants
Pathophysiology Biochemical
Diminished surface-active phospholipid
(phosphatidylcholine) Diminished apoprotein
content ( SP-A, B, C, D)
Reduced lung compliance (1/5th -1/10th) Poor lung
perfusion ( 50-60 not perfused) decreased
capillary blood flow R--gt L shunting ( 30-60 )
Alveolar ventilation decreased Lung volume
reduced Increased work of breathing Hypoxemia,
hypercarbia, acidosis
Clinical features Risk factors
Prematurity maternal diabetes maternal
bleeding perinatal asphyxia C-section without
labor White race male sex
Early onset, from birth to 6 hours uncomplicated
clinical course with progressive worsening until
day 2-3 onset of recovery by 72 hours Can be
severe leads to death from respiratory failure
and hypoxia The course of the disease can be
modified surfactant administration
Physical Examination
Signs of respiratory distress Cyanosis Tachypnea
Grunting) Retraction Flaring Temperature, Blood
pressure, Skin perfusion
2
Lab Investigations
Chest Xray ABG Hct, Bl.glucose CBC, Bl.cx,
Gastric aspirate To confirm diagnosis Shake
test on gastric aspirate Amniotic fluid L / S
ratio, SPC, PG
Classic presentation of
Grunting Retractions increasing O2
requirement reticulo-granular pattern and air
bronchograms on CXR onset lt 6hrs age Is not
always seen in lt 1000 g babies (respiratory
insufficiency of prematurity?)
Management Goals Respiratory
Prevent hypoxia and acidosis Prevent worsening
atelectasis, edema Minimize barotrauma and
hyperoxia
Supportive management
Optimize fluid and nutrition Management Perfusion,
Infection, Temperature control
Respiratory management
Surfactant replacement therapy Ventilatory
Assistance Oxygen therapy CPAP
( Nasal, ET, Face-mask ) Positive
pressure ventilation Negative pressure
ventilation High-frequency positive
pressure ventilation High-frequency
negative pressure ventilation ECMO
Liquid ventilation
Oxygen administration
Maintain PO2 50-80 mmHg. O2should be warm,
humidified Administer by Oxyhood, monitor
always with FiO2 monitor.
CPAP Concept
Prevents atelectasis reduces pulmonary
edema shifts infant to breathe on more
compliant portion of pressure volume curve
Problems
High CPAP may decrease venous return High CPAP
may decrease minute ventilation Abdominal
distension, open mouth, crying
Mechanical Ventilation
Indications
PCO2 gt55 or rapidly increasing / pHlt7.25 PO2 lt50
with FiO2 gt0.6-1.0 Severe apnea
No role for elective intubation, whatever the
birth weight Babies grow just as well, whether on
the ventilator or not. Risks of intubation and
barotrauma considerable. More ET / IMVMore BPD.
3
Supportive therapy
Temperature regulation

• A neutral thermal environment reduces
• Metabolism
• - O2 consumption
• - CO2 production

Fluid balance
Avoid excessive fluids which may increase
pulmonary edema and risk of PDA and BPD. Early
TPN
Most infants have spontaneous diuresis on Day 2-4
preceding improvement in pulmonary function.
Circulation
Maintain normal blood pressure. Dopamine may be
useful. Prevent anemia, monitor Hct.
Infection
Take cultures and treat with antibiotics for at
least 48 hr
PDA
look for and treat PDA aggressively
Complications
Acute complications Air leak
Pneumothorax, PIE, Pneumomediatinum
deterioration with hypotension, bradycardia,
apnea, acidosis ET complications Blocked /
dislodged ETT
Infection culture and treat rapidly Intracranial
hemorrhage monitor US PDA look for and treat
aggressively
Long-term complications
Bronchopulmonary dysplasia (BPD) 5-30 Retinopathy
of prematurity (ROP) 7 of lt1250 g Neurologic
impairment 10-15 of survivors of RDS -
associated with PVL, IVH, degree of prematurity
prevention