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Neonatal respiratory distress syndrome

Last updated: May 11, 2021

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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 suspected diagnosis is based on clinical features and confirmed by evaluating the extent of atelectasis via chest x-ray. Blood gases show respiratory and metabolic acidosis in addition to hypoxia. Treatment primarily involves emergent resuscitative measures, including nasal continuous positive airway pressure (CPAP) and stabilizing blood sugar levels and electrolytes. In addition, intratracheal surfactant is administered if ventilation alone is unsuccessful. Most cases resolve within 3–5 days of treatment. However, complications such as 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.

References:[1][2]

Epidemiological data refers to the US, unless otherwise specified.

References:[1]

References:[1][3]

  • History of premature birth
  • Onset of symptoms: usually immediately after birth but can occur within 48–72 hours postpartum
  • 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 pulmonary hypoxic vasoconstriction

References:[1][4][5]

References:[1][2][4][7][8][9]

Neonatal respiratory distress syndrome

Transient tachypnea of the newborn (wet lung disease) [10] Persistent pulmonary hypertension of the newborn (PPHN) [11] Meconium aspiration syndrome [12][13][14]
Gestation
Etiology
  • Delayed resorption of fetal lung fluid
Risk factors
Onset of symptoms
  • Within the first minutes/hours after birth
  • Immediately after birth and within the next 2 hours
  • Within 24 hours after birth
  • Immediately after birth
Clinical features
Imaging
Treatment
  • Supportive care
  • Administration of artificial surfactant
Complications
  • Resolves without complications in the majority of cases
  • Severe PPHN
    • Developmental delay
    • Motor deficit
    • Hearing deficit

The differential diagnoses listed here are not exhaustive.

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

References:[1][10][17]

Bronchopulmonary dysplasia (BPD)

Further complications

Baby oxen have RIBs: Babys receiving too much oxygen get Retinopathy of prematurity, Intraventricular hemorrhage, and Bronchopulmonary dysplasia.

References:[1][4][18][19]

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

  • Mortality rate: < 10% [20]
  • Most cases that are treated promptly resolve within 3–5 days.

References:[21]

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  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): p.L259-L271. doi: 10.1152/ajplung.00112.2007 . | Open in Read by QxMD
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  9. Sher G, Statland BE, Freer DE. Clinical evaluation of the quantitative foam stability index test. Obstet Gynecol. 1980; 55 (5): p.617-20.
  10. Reuter S, Moser C, Baack M. Respiratory distress in the newborn. Pediatr Rev. 2014; 35 (10): p.417-429. doi: 10.1542/pir.35-10-417 . | Open in Read by QxMD
  11. Abman et al. Guidelines From the American Heart Association and American Thoracic Society: Pediatric Pulmonary Hypertension. Circulation. 2015; 132 (21): p.2037-2099. doi: 10.1161/cir.0000000000000329 . | Open in Read by QxMD
  12. Usta et al.. Risk factors for meconium aspiration syndrome.. Obstet Gynecol. 1995; 86 (2): p.230-4.
  13. Dargaville PA. The Epidemiology of Meconium Aspiration Syndrome: Incidence, Risk Factors, Therapies, and Outcome. Pediatrics. 2006; 117 (5): p.1712-1721. doi: 10.1542/peds.2005-2215 . | Open in Read by QxMD
  14. Committee on Obstetric Practice. Committee Opinion No 689: Delivery of a Newborn With Meconium-Stained Amniotic Fluid. Obstet Gynecol.. 2017; 129 (3): p.e33-e34. doi: 10.1097/aog.0000000000001950 . | Open in Read by QxMD
  15. Townsel CD, Emmer SF, Campbell WA, Hussain N. Gender Differences in Respiratory Morbidity and Mortality of Preterm Neonates. Front Pediatr. 2017; 5 . doi: 10.3389/fped.2017.00006 . | Open in Read by QxMD
  16. Lakshminrusimha S, Keszler M. Persistent Pulmonary Hypertension of the Newborn. NeoReviews. 2015; 16 (12): p.e680-e692. doi: 10.1542/neo.16-12-e680 . | Open in Read by QxMD
  17. Le T, Bhushan V,‎ Sochat M, Chavda Y, Abrams J, Kalani M, Kallianos K, Vaidyanathan V. First Aid for the USMLE Step 1 2019. McGraw-Hill Medical
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