Definition:-
Infant respiratory distress syndrome (IRDS), also called neonatal respiratory distress syndrome (NRDS), respiratory distress syndrome of newborn, or increasingly surfactant deficiency disorder (SDD), and previously called hyaline membrane disease (HMD) is a syndrome in premature infants (< 34 weeks) caused by developmental insufficiency of pulmonary surfactant production and structural immaturity in the lungs.
" Major cause of death in premature infants"
Infant respiratory distress syndrome (IRDS), also called neonatal respiratory distress syndrome (NRDS), respiratory distress syndrome of newborn, or increasingly surfactant deficiency disorder (SDD), and previously called hyaline membrane disease (HMD) is a syndrome in premature infants (< 34 weeks) caused by developmental insufficiency of pulmonary surfactant production and structural immaturity in the lungs.
" Major cause of death in premature infants"
Aetiology
Surfactant:
- Production:
- Produced by type II alveolar cells
- Starts at 20 weeks gestation
- Peaks at 35 week gestation
- Therefore any neonate < 35 week is prone to develop RDS
- Function:
- ↓ surface tension in the alveoli
Pathophysiology
↓ Surfactant
↓
↓ Oxygenation + ↑ Work of breathing
↓
Hypoxemia + Acidosis
↓
Pulmonary vasoconstriction
↓
Right-to-left shunting
(Across foramen ovale)[ALVEOLI]
Ischemic damage
↓
Protein transudation
↓
Formation of hyaline membrane
Clinical features
Occurs within the first 6 hr of life
- Tachypnea
- Chest retractions
- Grunting
- Cyanosis
- Decreased air entry
Diagnosis
Imaging
X-ray
- ↓ surface tension in the alveoli
- Reticulogranular pattern
- Ground glass opacity
- Low lung volume
- Air bronchogram
- Severe cases:
- Whiteout lungs
Management
Prevention
Antenatal steroids
- Given to mothers in preterm labour (
- Reduces RDS, intraventricular haemorrhage and mortality in preterm neonates
Treatment
Admit to Neonatal intensive care unit (NICU)
Mild-to-moderate RDS
- Continuous positive airway pressure (CPAP)
- Surfactant:
- INtubated, given SURfactant and rapidly Extubated (lnSurE approach) to CPAP
Severe RDS
- Mechanical ventilation
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