Respiratory Distress Syndrome

• Etiology • Clinical Picture• Diagnosis• Differential Diagnosis• Prevention• Treatment

Definition

• RDS, previously called hyaline membrane disease:

• Criteria:• 1. PaO2 <50mmHg and central cyanosis• 2. CXR

Etiology: (↓surfactant, compliant chest wall, paradoxic

respn); diabetic mother, multiple births, LSCS, cold stress, asphyxia

•PATHOPHYSIOLOGY

Clinical PictureHx: -preterm- Hx of aphyxia in the perinatal period-resp distress developing within 6 hrs, cyanosis unresponsive to O2,P/e:-tachypnea, grunting, nasal flaring and retractions of

the chest wall-cyanosis under RA↓breath sounds, crackles, hypotension, met acidosis, oliguria, ileusProgressively worsening dyspnea & cyanosis, reaches

a peak in 3 days.

Diagnosis1.CXR2.Blood investigation-ABG, Sepsis

workup, glucose, serum eletrolytes and Ca2+

3.ECHO

STAGE 1

STAGE 2

STAGE 3

STAGE 4

Management

1. PREVENTION2. SURFACTANT REPLACEMENT

3. RESPIRATORY SUPPORT4. FLUID AND NUTRITIONAL SUPPORT

5. ANTIBIOTIC THERAPY6. SEDATION

Prevention

1. ANTENATAL CORTICOSTEROIDS2. PREVENTIVE MEASURES

SURFACTANT REPLACMENT-LIMITED to1.Preterm infants equal/< 32 weeks, or Bw

equal/< 1.5kg2. More mature or larger infants if RDS is severe

-TO BE GIVEN as soon as possible-METHOD of ADMINISTRATION

RESPIRATORY SUPPORT

1. INTUBATION AND MECHANICAL VENTILATION

2. CPAP3. SIMV

4.FLUID AND NUTRITIONAL SUPPORT

5. ANTIBIOTIC THERAPY

6. SEDATION