pediatrics
Respiratory Distress Syndrome in Neonates
Key Points
Respiratory distress syndrome (RDS) is caused by pulmonary surfactant deficiency, which typically occurs only in neonates born at<37 weeks gestation; deficiency is worse with increasing prematurity. With surfactant deficiency, alveoli close or fail to open, and the lungs become diffusely atelectatic, triggering inflammation and pulmonary edema. In addition to causing respiratory insufficiency, RDS increases risk of intraventricular hemorrhage, tension pneumothorax, bronchopulmonary dysplasia, sepsis, and death. Diagnose clinically and with chest x-ray; exclude pneumonia and sepsis by appropriate cultures. If preterm delivery is anticipated, assess lung maturity by testing amniotic fluid for lecithin/sphingomyelin ratio, foam stability, or the surfactant/albuminratio. Give the mother several doses of a parenteral corticosteroid (betamethasone,dexamethasone) if time allows and she must deliver between 24 weeks and 34 weeks gestation; corticosteroids induce fetal surfactant production and reduce the risk and/or severity of RDS. Give respiratory support as needed and treat with intratracheal surfactant if the infant requires immediate intubation or has worsening respiratory status on nasal continuous positive airway pressure. 