Respiratory Distress Syndrome in Neonates

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.