[PG Notes] RESPIRATORY DISTRESS SYNDROME ( ARDS ) [pathogenesis, clinical features, and management]



[pathogenesis, clinical features, and management and prevention ]

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



  • 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



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



  1. SUSPECTED Respiratory Distress Syndrome : Cared in NICU with IV fluids & Oxygen
  1. 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]
  1. SEVERE Respiratory Distress Syndrome: Require mechanical ventilation


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


TREATMENT OF CHOICEExogenous surfactant

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

Route of administration- INTRATRACHEAL

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  • 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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