Respiratory Distress Syndrome in Neonates

Study Notes

Respiratory Distress Syndrome (RDS)

RDS is a respiratory disorder specific to neonates, resulting from lung immaturity and deficiency in surfactant.
It is most commonly seen in premature infants.
RDS is the leading cause of respiratory failure in preterm neonates.

Causes and Predisposing Factors

Immature development of the respiratory system or inadequate amount of surfactant in the lungs.
Predisposing factors include:
- Premature infant
- Asphyxia at birth
- Infant of diabetic mothers
- Cesarean Section delivery
- Previous history of hyaline membrane disease (HMD) in sibling
- Multiple pregnancies

Pathophysiology of HMD

During intrauterine life, the alveoli are collapsed.
Crying of the neonate at birth creates enough negative pressure to open the collapsed alveoli.
Surfactant, a lipoprotein material, decreases the surface tension inside the alveoli, preventing their collapse during expiration.
If surfactant deficient, the alveoli cannot be easily distended during inspiration, leading to respiratory distress and hypoxemia.

Assessment Criteria of RDS

Clinical manifestations include:
- Tachypnea (80 to 120 breaths/min)
- Substernal retraction
- Fine inspiratory crackles
- Audible expiratory grunt
- Flaring of the nares
- Cyanosis or pallor
As the disease progresses:
- Flaccidity
- Unresponsiveness
- Apnea
- Diminished breath sound

Diagnostic Tests

Chest x-ray shows congested lung field with a ground-glass appearance, representing alveolar atelectasis.
Respiratory and metabolic acidosis is determined by blood gas analysis.

Therapeutic Management

Maintain adequate ventilation and oxygenation
Oxygen should be warmed and humidified
Maintain a neutral thermal environment
Maintain acid-base balance by correcting respiratory acidosis through assisted ventilation and correcting metabolic acidosis by IV administration of sodium bicarbonate.
Maintain adequate hydration and electrolytes level
Nutrition is provided by parenteral therapy during the acute stage
Surfactant therapy is installed in the trachea
Nipple and gavage feeding are contraindicated in any situation that creates a marked increase in respiratory rate.

Nursing Diagnosis and Interventions

Infective breathing pattern related to surfactant deficiency, alveolar instability, and pulmonary immaturity.
Impaired gas exchange related to immature alveolar structure and inability to maintain lung expansion.
Ineffective airway clearance related to obstruction or inappropriate positioning of endotracheal tube.
Risk for injury related to acid-base imbalance, oxygen levels, carbon dioxide levels from mechanical ventilation.
Interventions include:
- Close monitoring of oxygenation and respiratory status
- Frequent measurement of neonate’s vital signs
- Assessment of cardiac output, perfusion, fluid and electrolyte balance, and renal function
- Blood gas analysis, acid-base status, and pulse oximetry are important evaluation tools
- Skin inspection and care
- Changing position
- Mouth care
- Nutritional support
- Suctioning is performed only as necessary

Prevention and Prognosis

Prevention of HMD (RDS):
- Prevention of premature delivery
- Administration of corticosteroids to the mother (24 hours to 7 days before delivery)
- Prophylactic administration of artificial surfactant into the trachea of premature neonate
Prognosis of HMD (RDS):
- RDS is a self-limiting disease if mild, and following a period of deterioration (approximately 48 hours) and in the absence of complications, affected neonates begin to improve by 72 hours.

Description

Test your knowledge on Respiratory Distress Syndrome (RDS), a respiratory disorder specific to neonates resulting from lung immaturity and surfactant deficiency. Learn about the causes, symptoms, and predisposing factors of RDS in premature infants.