RDS
Dr. Fartun Orey
MBChB, MMED PAED
Differential Diagnosis
Pulmonary Parenchymal Disease
Respiratory Distress Syndrome (RDS)
Transient Tachypnea of the Newborn (TTN)
Meconium Aspiration
Interference with Pulmonary Mechanics
Pneumothorax
Pleural Effusion
Congenital Diaphragmatic Hernia (CDH)
Pulmonary Hypoplasia
Thoracic Wall abnormalities
Space occupying lesions
Differential Diagnosis
Cardiovascular
Congenital Heart Disease: Cyanotic
Acyantotic
Persistent Pulmonary Hypertension of Newborn
Anemia/Polycythemia
Neurologic
Perinatal Aphyxia (apnea,cerebral
edema and hemorrhage)
Maternal Drugs (narcotics, anesthesia)
Phrenic nerve injury
Neuromuscular disorders (myasthenia, spinal atrophy)
Differential Diagnosis
Infectious
Pneumonia
Sepsis
Metabolic
Acidosis
Hypoglycemia
Hypothermia
Most Common Respiratory
Conditions
Transient Tachypnea of Newborn (TTN)
Respiratory Distress Syndrome (RDS)
Meconium Aspiration Syndrome (MAS)
Sepsis
Pneumonia
RESPIRATORY DISTRESS SYNDROME
RDS occurs after the onset of breathing and is
associated with an insufficiency of pulmonary
surfactant.
Surfactantdeficiency–induced atelectasis
causes alveoli to be perfused but not
ventilated, which results in a pulmonary shunt
and hypoxemia.
Risk factors
Prematurity
Infant of diabetic mother
Hypothermia,
Fetal distress
Asphyxia,
Male sex, white race,
Being the second-born of twins,
And delivery by cesarean section without labor
Manifestations
Cyanosis, tachypnea, nasal flaring, intercostal and
sternal retractions, and grunting.
Chest [Link] shows a ground-glass haze in the lung
surrounding air-filled bronchi (the air bronchogram)
Severe RDS may show an airless lung field (whiteout)
During the first 72 hours, infants with untreated RDS
have increasing distress and hypoxemia.
In infants with severe RDS, develop edema, apnea, and
respiratory failure necessitates assisted ventilation.
Prevention
Prevention of preterm birth neonatal cold
stress, birth asphyxia, and hypovolemia
reduces the risk of RDS.
Antenatal administration of corticosteroids
(e.g., betamethasone) to the mother.
Intratrachealadministration of exogenous
surfactant immediately after birth
Treatment
The Pao2 level should be maintained between 60 and 70
mm Hg (oxygen saturation 90%), and the pH should be
maintained above 7.25.
Ifhypoxemia (Pao2 <50 mm Hg) is present, and the
needed inspired oxygen concentration is 70% to 100%,
nasal continuous positive airway pressure (CPAP).
Ifrespiratory failure ensues (Pco2 >60 mm Hg, pH <7.20,
and Pao2 <50 mmHg with 100% oxygen), assisted
ventilation using a ventilator is indicated.
TRANSIENT TACHYPNEA OF THE NEWBORN
Transient tachypnea of the newborn is a self-limited condition
characterized by tachypnea, mild retractions, hypoxia, and
occasional grunting, usually without signs of severe respiratory
distress.
Noted in larger premature infants and in term infants born by
precipitous delivery or cesarean section without prior labor and
infant of diabetic mother.
Transient tachypnea of the newborn may be caused by retained lung
fluid or slow resorption of lung fluid.
Muconium aspiration syndrome
Usually
associated with in utero passage of
meconium, meconium stained fluid
Associated with asphyxia (fetal heart rate pattern
abnormalities)
Increased risk in postdates, IUGR
Aspiration may lead to patchy alveolar disease,
air trapping (ball-valve), chemical pneumonitis,
persistent pulmonary hypertension
Can cause surfactant inactivation
Clinical manifestation
Mild disease: similar to TTN
Moderate disease: gradual increase in
respiratory distress with rising 02 needs
Severe
disease: Early respiratory symptoms,
may be associated with severe hypoxemia.
Management
Early preventive management:
Intubation and endotracheal suctioning in infants
in non-vigorous infant with meconium.
Diagnosis:
Hypoxemia
Respiratorydistress (grunting, flaring, retractions,
and tachypnea)
CXR
Coarse irregular patchy infiltrates
Hyperinflation
