RESPIRATORY DISTRESS SYNDROME

What is RDS?
Respiratory Distress Syndrome occurs most commonly in premature neonates weighing between 1000-1500 gms and between 28-27 weeks of gestation.



Definition:
“RDS formerly known as Hyaline membrane disease is a syndrome of premature neonates that is characterized by progressive & usually fatal respiratory failure resulting from atelectasis & immaturity of lungs”.

Pathophysiology:
Deficiency of surfactant leads to lung incompetence causing decrease alveolar function  resulting in reduced lung volume may result in atelectasis.

Etiology & Risk factors:

• Decreased pulmonary surface
• Hypoxia
• Intrapartum stress
• Maternal hypertension
• Sepsis
• Apnic episodes 
• Acidosis
• Hypothermia
• Intracranial hemorrhage
• Cardiac defects

Sign & Symptoms:
Primary symptoms:

• Nasal flaring
• Tachypnea > 60bpm
• Hypothermia
• Cyanosis
• Apnea
• Bradycardia
• Expiratory grunting
• Pulmonary edema

Secondary Symptoms:

• Hypotension
• Peripheral edema
• Decrease urine output
• Absent bowel sound

Medical & Nursing Management:

• Maintain suitable environment to keep normal body temperature.
• Oxygen administration by O2 hood or nasal prongs.
• SPO2 should be maintained at 90-93% for neonates & 88-92% for preterm neonates.
• Iv fluids.
• Antibiotics.
• NG tube.
• Infection control measures
• Intubation with PEEP mode ventilation.
• Surgical interventions may be planned as per situations.
• Drugs such as Aminophylline to treat apnea.
• Surfactant Replacement therapy.

Distinctive facts:

• Ix: Silverman Anderson score, Downes score, CXR, PFT
• ABG Analysis might show following results:

paco2 =increase
Pao2  = decrease
ph = decrease
Calcium = decrease
Glucose = decrease

• Adapt InSurE technique:

Intubate
Surfactant
Extubation to CPAP mode

• Complications include: Pneumothorax, Emphysema, Heart failure, Retrosternal fibroplasia, Tracheal stenosis.

 

Prognosis :
Prognosis depends on severity of symptoms.
Prevention can be done by early identification of cause.
Antenatal corticosteroid therapy should be given in preterm labor before 34 weeks of pregnancy.