Pediatric Module

Respiratory Distress
Syndrome
under Supervision

Prof /Hossny Mohamed EL-Masry

BY: Group 6
1- Salma Sobhy Mohamed.

2-Sarah Ibrahim Mahmoud Shalan.

3-Shrouk Shrief Elsayed saleh.

4-Shrouk Elsayed Helmy.

Respiratory Distress
Syndrome
(Hyaline Membrane disease )
Introduction
Respiratory disorders are responsible for a major
percentage of neonatal Morbidity and Mortality,
especially in preterm infants.
Etiology of Respiratory Disorder
Pulmonary causes

A-Air ways Obstruction

1-Bilateral coanal atresia .

2-Macroglossia , Micrognathia , Pierre-Robin syndrome.

3-Laryngeal obstruction (congenital Laryngeal web , stenosis , FB).

4-Tracheal obstruction (stenosis , FB , compression).

5-Bronchial obstruction (compression) - thick meconium or mucus plug .

B- Lungs

1-Hyaline membrane disease (RDS).

2-Transient Tachypnea of new born (TTN).

3-Meconum aspiration syndrome (MAS).

4-Pnemonia .

5-Air leak syndrome (pneumothorax).

Extrapulmonary causes of RD
1-CNS disorders : HIE ,ICU, infection .

2-CVS : heart failure , PDA ,VSD.

3-Hematologic : Anemia, polycythemia.

4-Metabolic :

A- Hypothermia / Hyperthermia.

B-Hypoglycemia.

C-Hypocalcemia.
Definition and Incidence of Respiratory
Distress Syndrome
Definition

RDS is a common lung disorder in newborns that causes breathing

difficulties due to inadequate surfactant production.

Incidence

RDS is the most common respiratory disorder especially in preterm

neonate and occurs primary in preterm infants < 34 weeks of GA
(Gestational age) .
Etiology and
pathophysiology
RDS is due to surfactant deficiency that lead to
progressive alveolar collapse (atelectasis ) during
expiration and poor lung compliance during
inspiration (stiff lung )

surfactant is a surface tension reducing

substance secreted by type 2 alveolar cells that
prevent collapse (atelectasis ) of the alveoli and
small air spaces during expiration
Pathology and Pathogenesis of RDS
Gross:

liver like consistency of the lung

Microscopic :

Extensive atelectasis (collapse).

Alveoli are lined with acidophilic

(hyaline membrane).
Risk Factors of RDS
Increased risk Decreased risk

1-prematurity (<35 w) 1-chronic intrauterine stress

2-ceasearn section 2-Maternal hypertension

3-infants of diabetic mothers 3-IUGR

4-Male sex 4-Narcotic use

5-Familial predisposition 5-prenatal corticosteroids

6-Maternal pulmonary or CV diseases 6-PROM

7-perinatal asphyxia

8-Multiple pregnancy

9-Hydrops fetalis
clinical
Manifestations
Signs of RDS usually appear within few hours (2-4
)after birth

1-Tachypneia

2-Intercostal and subcostal retraction

3-Nasal flaring

4-Grunting

5-Cynosis on room air

6- Diminished breath sounds and room entry

7-Fine rales may be heard posteriorly over lung

bases
Downes' Score
Downes' score 0 1 2

Respiratory Rate < 60/min 60-80/min 80 min

Retractions None Mild Severe

Cyanosis None Cyanosis relieved by O2 Cyanosis not

relieved by O2

Air entry Good Mildly decreased Markedly decreased

bilaterally

Grunting None Audible with Audible with ear

stethoscope

0-3- No/mild respiratory distress.

4-7-Moderate respiratory distress.

8-10-Severe respiratory distress with impending respiratory failure.

Prediction of RDS
Pulmonary Surfactant tests

Prenatal Natal and post-Natal

Lecithin / sphingomyelin ratio (L/S ratio )
in the amniotic fluid .
Values > 2:1 indicates a sufficient
surfactant and RDS is less likely
Tests are done on amniotic fluid , gastric
aspirate (before feeding ) , or tracheal
aspirate.
1-Shake test.
2-Stable micro bubble test .
Investigations of Respiratory Distress
Syndrome
1-X-ray chest

• Fine reticulogranularity of the lung

parenchyma , ground glass
• appearance
Air bronchogram
• white lung and decreased lung volume

2-Arterial blood gas (ABG)

hypoxia

hypercarbia

Acidosis (respiratory or respiratory and

metabolic)

3-CBC, CRP, Na , K , Cl ,Ca , Mg and Glucose

are normal

4-culutures are negative .

Treatment Options for Respiratory
Distress Syndrome
prevention

Adequate antenatal care for early identification and proper management of high risk
pregnancies and Antenatal Betamethasone (12 mg IM , 2 doses 24 hours interval ) for
expected premature delivery.

supportive

1-Thermal regulation (incubator care )

2-I.V fluids and nutrition

3-Medications (Antibiotic)

4-correction of acid base balance

5-Mantain adequate tissue perfusion (fluid resuscitation , dopamine )

6-Mointoring of vital signs, pulse oximetry and ABG

CONT….Treatment

Oxygen Therapy and

Respiratory support
1-oxygen should

be heated and humidified

2-Mode of administration

Nasal cannula , Head box , CPAP and

Mechanical ventilator

3-Goals: to maintain

PH : 7.35-7.45

Paco2:55-70 mmHg

HCO3:22-24 mmol/L
CONT……Treatment

Indication of Mechanical Ventilation in this case:

1-PO2 <50 mmHg

2-PCO2 > 60-70 mmHg

CONT…Treatment
Specific

1-surfactant replacement

2-It is administrated through the

endotracheal tube

3-It is used either prophylactic

(before lung injury) or rescue therapy

Complications of Respiratory Distress
Syndrome
Acute chronic (long term )

1-Air leak (pneumothorax ) 1-chronic lung disease

(Bronchopulmonary dysplasia)
2-Infection (Staph , pseudomonas)
2-Retinopathy of prematurity
3-Intraventricular hemorrhage (IVH)
(Retrolental fibroplasia)
4-Patent ductus arteriosus (PDA)
3-Neurologic impairment (periventricular
leukomalacia)
case
A newborn 32 gestational age born to diabetic mother after birth within 2 hour develop
progressive cyanosis and grunting. The chest radiography reveals a ground glass appearance
and air bronchogram pattern.

1-What's most likely diagnosis?

2-What's laboratory investigation should be done?

3-In your opinion why infant develop this symptoms?

4-What's the first line in treatment?

Answers of case
1- Respiratory Distress Syndrome.

2-ABG : Hypoxia, Hypercapnia and Acidosis (respiratory or respiratory and metabolic).

3-Premature Infant born to diabetic mother.

4-Oxygen therapy By mechanical ventilation.

MCQs 1
1-Grading of respiratory distress include the following except:-

a-Cyanosis.

b- Tachycardia.

c- Tachypnea.

d- Grunting.

2-The following are complications of respiratory distress except :-

a_ Pierre Robin syndrome.

b- Retinopathy of prematurity.

c- Air leak.

d-PDA.
MCQ 2
3-Most Common cause of Respiratory disorder in preterm:-

a-Transient Tachypnea of the newborn.

b- Meconium aspiration syndrome.

c-Air leak syndrome.

d- Hyaline membrane disease .

4-which of the following is specific therapy for RDS:

a-Betamethasone.

b- Oxygen therapy.

c- Surfactant replacement.

d-None of the above.

MCQ 3
5-Clinical findings in chest x-ray in case of RDS :-

a- Ground glass appearance.

b-White lung .

c-Air bronchogram.

d-All of the above.

6-All the following Decrease risk of respiratory distress except:

a- Chronic intra uterine stress.

b- Prenatal corticosteroids.

c- Maternal cardiovascular disease.

d-IUGR .
MCQ 4
7-All of the following increase risk of respiratory distress except :-

a-Cesarean section.

b-Male sex.

c-Prematurity.

d-Prenatal corticosteroids.

8-Which of the following is a commonly used non-invasive ventilation technique in the

management of RDS?

a) High-frequency oscillatory ventilation (HFOV).

b) Invasive mechanical ventilation.

c) Continuous positive airway pressure (CPAP) .

d) Extracorporeal membrane oxygenation (ECMO).

MCQ 5
9-Which of the following laboratory findings is associated with RDS in newborns?

a) Elevated white blood cell count.

b) Increased platelet count.

c) Metabolic alkalosis.

d) Decreased oxygen saturation.

10-Which of the following is a common early sign of respiratory distress in newborns ?

a) Bradycardia .

b) Peripheral edema..

c) Nasal flaring .

d) Hypoglycemia.
Answers
1- B (Tachycardia).

2-A (Pierre Robin syndrome).

3-D (Hyaline membrane disease ).

4-C (Surfactant replacement).

5-D (All of the above).

6-C (Maternal cardiovascular disease).

7-D (Prenatal corticosteroids).

8-C (Continuous positive airway pressure (CPAP)).

9-D (Decreased oxygen saturation).

10- C (Nasal flaring).

Thank You …..