RESPIRATORY DISTRESS SYNDROME

[pathogenesis, clinical features, and management and prevention ]

Aka HYALINE MEMBRANE DISEASE
Incidence-
- Overall: 10 to 15%
- in < 28weeks of gestation: 80%
Risk factors: Prematurity, asphyxia, acidosis, maternal diabetes, C-section

I. ETIOPATHOGENESIS

Normally:

Type 2 alveolar cells -> produce surfactant -> helps reduce surface tension

In RDS: Basic abnormality is surfactant deficiency.

Pathogenesis Of Respiratory Distress Syndrome/ Hyaline Membrane Disease

Surfactant deficiency -> alveoli collapse -> ventilation perfusion mismatch -> hypoxia and acidosis -> pulmonary vasoconstriction -> alveolar hypoperfusion -> ischaemic damage to alveoli -> transudation of proteins in alveoli -> form hyaline membrane

Surfactant production
- Starts around: 20 weeks
- Peak: 35 weeks
- That’s why any neonate <35week is prone to develop RDS

II. CLINICAL FEATURES

Occur within 1^st 6 hours of life
Clinical Features:
- Tachpnoea
- Retraction
- Grunting
- Cyanosis
- DECREASED air entry
Radiological feature
- Retinogranular pattern
- Ground glass opacity[mcQ]
- Low lung volume
- Air bronchogram[mcQ]
- In severe disease- White out lungs

III. MANAGEMENT

SUSPECTED Respiratory Distress Syndrome : Cared in NICU with IV fluids & Oxygen

MILD to MODERATE Respiratory Distress Syndrome: Managed with CPAP [Continuous distending pressure of 5-7cm of water applied at the level of nostrils to keep alveoli open in spontaneously breathing baby]

SEVERE Respiratory Distress Syndrome: Require mechanical ventilation

InSurE approach
- INtubated
- SURfactant given
- Extubated rapidly to CPAP

TREATMENT OF CHOICE– Exogenous surfactant

Indication- Moderate to severe RDS + Prophylaxis (all neonates <28weeks)

Route of administration- INTRATRACHEAL

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IV. PREVENTION

Antenatal steroids given to mother in preterm labor (<35weeks)
- induce phospholipid synthesis and release of surfactant
- Enhance lung maturation process
- Betamethasone phosphate OR acetate (6mg) administered 24-72 hours prior to delivery

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This is all you Need to Know About Hyaline Membrane Disease or Respiratory Distress Syndrome for NEET PG or Your Pediatrics in Final Year MBBS.

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