Respiratory Distress Syndrome

Respiratory distress syndrome (RDS) is a respiratory disorder that is specific to

neonates that results from lung immaturity and a deficiency in surfactant, so it is seen
most often in premature infants.
 Other infants who might experience RDS include
1. Infants of diabetic mothers
2. Infants delivered via cesarean section without preceding labor
3. Infants experiencing perinatal asphyxia
 It is believed that each of these conditions has an impact on surfactant
production, thus resulting in RDS in the term infant.
Pathophysiology-
 The lack of surfactant in the affected newborn's lungs results in stiff, poorly compliant
lungs with poor gas exchange. Right-to-left shunting and hypoxemia result.
 As the disease progresses, fluid and fibrin leak from the pulmonary capillaries,
causing a hyaline membrane to form in the bronchioles, alveolar ducts, and alveoli.
 Presence of the membrane further decreases gas exchange.

Complications of RDS
 Air leak syndrome
 Bronchopulmonary dysplasia
 Patent ductus arteriosus
 Congestive heart failure
 Intraventricular haemorrhage
 Retinopathy of prematurity
 Necrotizing enterocolitis
 Complications resulting from intravenous catheter use (infection, thrombus
formation)
 Developmental delay or disability.

Therapeutic Management
 The administration of surfactant via an endotracheal tube shortly after delivery helps
to decrease the incidence and severity of RDS.
 Therapeutic management of RDS focuses on intensive respiratory care, usually
with mechanical ventilation
Onset of Illness

 The onset of RDS is usually within several hours of birth.

Signs & Symptoms

  Tachypnea
 Retractions
 Nasal flaring
 Grunting
 Varying degrees of cyanosis.
 Fine rales and diminished breath sound on auscultation

Complications
 Seesaw respirations
 Respiratory failure
 Shock

Acute Respiratory Distress Syndrome

Acute respiratory distress syndrome (ARDS) occurs following a primary insult such as
sepsis, viral pneumonia, smoke inhalation, or near drowning.
Pathophysiology-

 Respiratory distress and hypoxemia occur acutely within 72 hours of the insult in
infants and children with previously healthy lungs
 The alveolar-capillary membrane becomes more permeable and pulmonary edema
develops.
 Hyaline membrane formation over the alveolar surfaces and decreased surfactant
production cause lung stiffness.
 Mucosal swelling and cellular debris lead to atelectasis.
 Gas diffusion is impaired significantly.
 Some children have residual lung disease and some recover completely. However,
ARDS can progress to respiratory failure and death.
Therapeutic management- Is aimed at improving oxygenation and ventilation.
 Mechanical ventilation is used, with special attention to lung volumes and positive
end-expiratory pressure (PEEP).
Signs & Symptoms-
 Tachycardia and tachypnea occur over the first few hours of the illness.
 Significantly increased work of breathing with nasal flaring and retractions develops.
 Breath sounds that range from normal to high-pitched crackles throughout the lung
fields.
 Hypoxemia
 Bilateral infiltrates can be seen on a chest radiograph.