RESPIRATORY DISTRESS

SYNDROME
INCIDENCE
• occurs primarily in premature infant; incidence
is inversely related to AOG and BW

• occurs 60-80% of infants in <28wks AOG; in

15-30% of those between 32-36 wks and
rarely in >37 wks.
RISK FOR DEVELOPMENT OF RDS
Increases with:
• maternal diabetes
• multiple births
• CS
• precipitous delivery
• asphyxia
• cold stress
• maternal hx of prev affected infants
ETIOLOGY
• Surfactant deficiency- primary cause of RDS
• Mature levels of pulmonary surfactant are
present usually after 35 wks AOG.
• Asphyxia, hypoxemia, and pulmonary
ischemia may suppress surfactant synthesis.
CLINICAL MANIFESTATIONS
• tachypnea, prominent (often audible)
grunting, intercostal, and subcostal retractions,
nasal flaring, and cyanosis are noted.
• breath sounds may be normal or diminished
with a harsh tubular quality, and on deep
inspiration, fine rales may be heard.
• Apnea and irregular respirations are ominous
signs requiring immediate intervention.
DIAGNOSIS
• X-ray findings:
low lung volume
Diffuse “ground glass” appearance with air
bronchogram
PREVENTION
• Avoidance of unnecessary or poorly timed
cesarean section (<39 weeks)
• Prediction of pulmonary immaturity
• Antenatal and intrapartum fetal monitoring for
fetal asphyxia
• Administration of antenatal corticosteroids to
women before 34 weeks of gestation
TREATMENT/ MANAGEMENT
• Early supportive care
• Mechanical ventilation
– CPAP: reduces alveolar atelectasis
• If persistent, intubated and surfactant is given
via endotracheal tube