RESPIRATORY DISTRESS

SYNDROME
AHSAN HASNAIN DAFTRI
ROLL NO. 86
LEARNING OUTCOMES:
 INTRODUCTION.
 CAUSES.
 RISK FACTORS.
 ROLE OF SURFACTANT.
 PATHOGENESIS.
 MORPHOLOGY.
 CLINICAL FEATURES.
 DIAGNOSIS.
 TREATMENT & Prevention.
INTRODUCTION:

 Also called Hyaline Membrane Disease (Proteineous Hyaline

Material in the Alveoli that impair gas exchange).
CAUSES:

 Immaturity of Lungs in Preterm Babies (Less than 28 weeks).

 Lack of Lung Surfactant Production.
RISK FACTORS:

 Maternal Diabetes: -High Level of Glucose in Fetal Circulation.

-Beta Cells of Pancreas Synthesize
Insulin.
-Causes Hyperinsulinemia.
-Decrease the Synthesis of Surfactant.
 C-Section decrease the synthesis of Surfactant.
 Labor increases the synthesis of surfactant.
 Male Gender
ROLE OF SURFACTANT:

 Synthesized & Stored by Type 2 pneumocytes.

 Reduce the surface tension of alveoli.
 Composition: -Dipalmitoyl Phosphatidylcholine (Lecithin).
-Smaller Amount of Phosphatidylglycerol.
 Surfactant Related Proteins (Hydrophobic + Hydrophobic).
PATHOGENESIS:
Prematurity of Lungs
Decrease Surfactant Synthesis, Storage & Release
Decrease Surfactant on Alveolar Surface
Increase Alveolar Surface Tension
Atelectasis (Collapse of Lungs)
Uneven Perfusion Hypoventilation
Hypoxemia Co2 Retention
Acidosis
Pulmonary Vasoconstriction
Pulmonary Hypoperfusion
Endothelial & Epithelial Injury
Leakage of Plasma into Alveoli
Necrotic Cell & Fibrosis (Hyaline Membrane)
MORPHOLOGY:

 On Gross: Lungs are dark red, firm, airless & heavy.

 On Microscope: Poorly Developed Alveoli + Collapse Alveoli +
Characterized Eosinophilic Hyaline Membrane Lining the
respiratory bronchioles, alveolar ducts & alveoli + Necrotic cell
Debris and Fibrin + Neutrophilic Infiltrate
CLINICAL FEATURES:

 Tachypnea (Increase in Respiratory Rate).

 Nasal Flaring (Nostril Wide in Respiration).
 Cyanosis.
 Hypoxemia (Lack of Oxygen).
 Intracoastal & Subcoastal Retraction.
DIAGNOSIS:

 Chest X Ray
 Uniform Reticular Granular Densities
 Ground Glass Appearance
 Features of Atelectasis
 Respiratory + Metabolic Acidosis
 Lecithin: Sphingomyelin Ratio (Less than 1.50)
TREATMENT & PREVENTION:

 Oxygen Therapy
 Nasal Continuous Positive Airway Pressure
 Exogenous Surfactant
 Antenatal Glucocorticoid Therapy