• Clinical science

Neonatal respiratory distress syndrome (Infant respiratory distress syndrome…)

Abstract

Content currently under development

Neonatal respiratory distress syndrome (NRDS), or surfactant deficiency disorder, is a lung disorder in infants that is caused by a deficiency of pulmonary surfactant. It is most common in preterm infants, with the incidence and severity decreasing with gestational age. Surfactant deficiency causes the alveoli to collapse, resulting in impaired blood gas exchange. Symptoms manifest shortly after birth and include tachypnea, tachycardia, increased breathing effort, and/or cyanosis. The diagnosis is suspected based on clinical features and confirmed by evaluating the extent of atelectasis via chest x-ray. Blood gases show respiratory and metabolic acidosis, as well as hypoxia. Treatment primarily involves emergent resuscitative measures, which include nasal CPAP and stabilization of blood sugar levels and electrolytes. Additionally, intratracheal surfactant is administered if ventilation alone is not successful. Most cases resolve within 3–5 days of treatment. However, complications like hypoxemia, tension pneumothorax, bronchopulmonary dysplasia, sepsis, and neonatal death may still occur. NRDS can be prevented by administering antenatal glucocorticoids to the mother if premature delivery is expected.

Epidemiology

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References:[1][2]

Epidemiological data refers to the US, unless otherwise specified.

Etiology

Content currently under development

  • Impaired synthesis and secretion of surfactant
  • Risk factors that predispose to NRDS
  • Rarely, hereditary

References:[1]

Pathophysiology

Content currently under development

References:[1][3]

Clinical features

Content currently under development

  • History of premature birth
  • Onset of symptoms: usually presents immediately after birth
  • Signs of increased breathing effort
    • Tachypnea
    • Nasal flaring and moderate to severe subcostal/intercostal and jugular retractions
  • Typical expiratory “grunting”
  • Auscultation: decreased breath sounds
  • Cyanosis due to peripheral hypoxic vasoconstriction

References:[4][1][5]

Diagnostics

Content currently under development

References:[4][1][2]

Differential diagnoses

Content currently under development

References:[6][7]

The differential diagnoses listed here are not exhaustive.

Treatment

Content currently under development

  • Ventilation:
    1. Nasal CPAP with a PEEP of 3–8 cm H2O
    2. If respiratory insufficiency persists, intubation with mechanical ventilation and O2 inhalation (target O2 saturation of 90%)
  • Endotracheal administration of artificial surfactant within 2 hours postpartum
  • Supportive measures: IV fluid replacement; stabilization of blood sugar levels and electrolytes

Physiologic O2 saturation in neonates is around 90% instead of 100%. A saturation of 100% is considered toxic for the neonate!

References:[1][7]

Complications

Content currently under development

Bronchopulmonary dysplasia (BPD)

Further complications

References:[4][1][8][9]

We list the most important complications. The selection is not exhaustive.

Prognosis

Content currently under development

  • Neonatal RDS has a case fatality rate of 30% if not treated.
  • Most cases that have been diagnosed and promptly treated resolve within 3–5 days of treatment.

Prevention

Content currently under development

References:[10]

  • 1. Pramanik AK. Respiratory Distress Syndrome. In: Rosenkrantz T. Respiratory Distress Syndrome. New York, NY: WebMD. http://emedicine.medscape.com/article/976034. Updated January 16, 2015. Accessed May 11, 2017.
  • 2. Besnard AE, Wirjosoekarto SAM, Broeze KA, Opmeer BC, Mol BWJ. Lecithin/sphingomyelin ratio and lamellar body count for fetal lung maturity: a meta-analysis. Eur J Obstet Gynecol Reprod Biol. 2013; 169(2): pp. 177–183. doi: 10.1016/j.ejogrb.2013.02.013.
  • 3. Andreeva AV, Kutuzov MA, Voyno-Yasenetskaya TA. Regulation of surfactant secretion in alveolar type II cells. Am J Physiol Lung Cell Mol Physiol. 2007; 293(2): pp. L259–L271. doi: 10.1152/ajplung.00112.2007.
  • 4. Le T, Bhushan V, Bagga HS. First Aid for the USMLE Step 2 CK. McGraw-Hill Medical; 2009.
  • 5. Hermansen CL, Mahajan A. Newborn Respiratory Distress. Am Fam Physician. 2015; 92(11): pp. 994–1002. pmid: 26760414.
  • 6. Radswiki, et al. Meconium Aspiration. https://radiopaedia.org/articles/meconium-aspiration. Updated January 1, 2017. Accessed November 15, 2017.
  • 7. Reuter S, Moser C, Baack M. Respiratory distress in the newborn. Pediatr Rev. 2014; 35(10): pp. 417–429. doi: 10.1542/pir.35-10-417.
  • 8. Kinsella JP, Greenough A, Abman SH. Bronchopulmonary dysplasia. The Lancet. 2006; 367(9520): pp. 1421–1431. doi: 10.1016/s0140-6736(06)68615-7.
  • 9. Rajiah P. Imaging in Bronchopulmonary Dysplasia. In: Lin EC. Imaging in Bronchopulmonary Dysplasia. New York, NY: WebMD. https://emedicine.medscape.com/article/406564-overview. Updated August 25, 2016. Accessed January 25, 2018.
  • 10. Romejko-Wolniewicz E, Teliga-Czajkowska J, Czajkowski K. Antenatal steroids: can we optimize the dose?. Curr Opin Obstet Gynecol. 2014; 26(2): pp. 77–82. doi: 10.1097/gco.0000000000000047.
  • Gibson E, Nawab U. Respiratory Distress Syndrome in Neonates (Hyaline Membrane Disease). http://www.msdmanuals.com/professional/pediatrics/perinatal-problems/respiratory-distress-syndrome-in-neonates#v1089988. Updated January 1, 2015. Accessed May 11, 2017.
  • Kaplan. USMLE Step 2 CK Lecture Notes 2017: Pediatrics. New York, NY: Kaplan; 2016.
  • Le T, Bhushan V,‎ Sochat M, Chavda Y, Zureick A. First Aid for the USMLE Step 1 2018. New York, NY: McGraw-Hill Medical; 2017.
  • Wilmott RW, Kendig EL, Boat TF, Bush A, Chernick V. Kendig and Chernick's Disorders of the Respiratory Tract in Children. Elsevier Health Sciences; 2012.
  • Sher G, Statland BE, Freer DE. Clinical evaluation of the quantitative foam stability index test. Obstet Gynecol. 1980; 55(5): pp. 617–20. pmid: 6892727.
last updated 12/13/2018
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