Makindo Medical Notes

Related Subjects:Sick Neonate |APGAR Scoring |Approach to Assessing Sick Child |Sick Child with Acute Gastroenteritis |Sick Child with Respiratory Distress Asthma |Acute Severe Asthma |Respiratory Failure |

Main cause of death in premature babies.

About

• Respiratory Distress Syndrome (RDS) is a common cause of morbidity and mortality in premature infants.
• It is the leading cause of death in premature babies, especially those born before 32 weeks of gestation.
• Also known as hyaline membrane disease due to the characteristic formation of hyaline membranes in the alveoli.

Aetiology

• Caused by a deficiency of surfactant, a substance that reduces surface tension in the lungs and prevents alveolar collapse.
• Premature infants, especially those born at < 28 weeks, are at the highest risk due to immature lung development.
• Incidence: Nearly 100% at 24-28 weeks, reducing to around 50% at 32 weeks gestation.

Clinical Presentation

• Signs: Tachypnoea (rapid breathing), respiratory distress, and cyanosis (bluish skin tone due to low oxygen).
• Physical Examination: Intercostal and subcostal retractions, nasal flaring, and audible grunting as the infant attempts to keep alveoli open.

Differentials

• Transient Tachypnoea of the Newborn (TTN): Often seen in term or near-term infants with delayed fluid clearance from the lungs.
• Meconium Aspiration Syndrome: Respiratory distress in term or post-term infants who inhale meconium-stained amniotic fluid.

Investigations

• Arterial Blood Gas (ABG): Typically shows Type 1 respiratory failure (hypoxemia without hypercapnia).
• Chest X-Ray (CXR): Shows a "ground-glass" or granular pattern, air bronchograms, and low lung volumes.

Management

• Prevention: Administration of antenatal corticosteroids to mothers at risk of preterm delivery (24-34 weeks) to promote fetal lung maturity, though potential side effects include raised blood glucose, gastrointestinal bleeding, and intestinal perforation.
• Supportive Care:
  • ABCs: Ensure airway, breathing, and circulation are stabilized.
  • Oxygen supplementation as needed, aiming to maintain target oxygen saturations.
  • Intubation and early administration of exogenous surfactant via endotracheal (ET) tube are recommended for severe cases.
  • Continuous Positive Airway Pressure (CPAP): Helps keep alveoli open and improves oxygenation.
• Additional Care:
  • Fluid and electrolyte management, cautious hydration to avoid pulmonary edema.
  • Trophic feeding and gradual enteral nutrition to support growth and development.
  • Use of prophylactic Fluconazole in very low birth weight infants to prevent fungal infections.
• Palliative Care: May be necessary if prognosis is poor and a baby is not expected to survive.

References