Respiratory Distress

Syndrome

Resident Lecture Series

Soo Hyun Kwon, MD
Neonatal-Perinatal Fellow

Overview

Definition
Epidemiology
Lung Development
Pathophysiology
Risk Factors
Clinical Manifestations
DDx
Diagnosis
Treatment

Objectives
Define respiratory distress syndrome (RDS).
Discuss the epidemiology, pathophysiology, and
diagnosis of RDS.
List a differential diagnosis for respiratory
distress in the neonate.
Describe the treatments for RDS.
Discuss ventilation strategies that can be used in
the infant who has RDS.
Describe long-term complications of RDS and its
treatments.

Definition
Formerly known as hyaline
membrane disease
Deficiency of pulmonary surfactant
in an immature lung
Disease of prematurity

Epidemiology
Major cause of morbidity and mortality in preterm
infants
20,000-30,000 newborn infants each year

Incidence and severity of RDS are related

inversely to gestational age of newborn infant
26-28 weeks' gestation : 50%
30-31 weeks' gestation : <30%

Overall incidence in 501-1500 grams: 42%

501-750 grams: 71%

751-1000 grams: 54%
1001-1250 grams: 36%
1251-1500 grams: 22%

Phases of Lung Development

Lung Development

Surfactant
Complex
lipoprotein
Composed of 6
phospholipids and 4
apoproteins
70-80%
phospholipids, 810% protein, and
10% neutral lipids

Surfactant Metabolism

Assessment of Fetal Lung

Maturity
Lecithin/sphingomyelin (L/S) ratio
Lamellar body counts
Phosphatidylglycerol
After 35 weeks gestation

L/S Ratio

Pathophysiology

Etiology
Preterm delivery
Mutations in genes encoding
surfactant proteins
SP-B
SP-C
ATP-binding cassette (ABC) transporter
A3 (ABCA3)

Lung Compliance

Normal Lung

Hyaline Membranes

Risk Factors
Prematurity
Maternal diabetes
C-section delivery
Asphyxia

Surfactant Inactivation
Meconium and blood can inactivate
surfactant activity (Full-term >
Preterm)
Proteinaceous edema and
inflammatory products increase
conversion rate of surfactant into its
inactive vesicular form
Oxidant and mechanical stress
associated with mechanical ventilation
that uses large TV

Clinical Manifestations
Tachypnea
Nasal flaring
Grunting
Intercostal, subxiphoid, and
subcostal retractions
Cyanosis

Differential Diagnosis

TTN
MAS
Pneumonia
Cyanotic Congenital Heart Disease
Pneumomediastinum, pneumothorax
Hypoglycemia
Metabolic problems
Hematologic problems
Anemia, polycythemia

Congenital anomalies of the lungs

Diagnosis
Onset of progressive respiratory
failure shortly after birth
Characteristic chest radiograph
ABG
Hypoxia
Hypercarbia

CXR

Prevention
Antenatal glucocorticoids
Enhances maturational changes in lung
architecture and inducing enzymes
Stimulate phospholipid synthesis and release
of surfactant
All pregnant mothers at risk for preterm
delivery at or below 34 weeks gestation should
receive ACS

Treatment
Surfactant Therapy
Assisted Ventilation Techniques
Supportive Care
Thermoregulation
Fluid Management
Nutrition

References
Jobe AH. Why Surfactant Works for Respiratory Distress Syndrome.
NeoReviews. 2006; 7: 95-106.
Pramanik AK, et al. Respiratory distress syndrome.
http://emedicine.medscape.com/article/976034-overview.
Saker F, Martin R. Pathophysiology and clinical manifestations of
respiratory distress syndrome in the newborn. Uptodate.
http://www.utdol.com
Warren JB, Andersen JM. Respiratory distress syndrome.
Neoreviews. 2009; 7: 351-361.

Questions or Comments?