During morning rounds you are presented with a neonate who was born by emergency cesarean section at 32 weeks due to complications of maternal diabetes. The infant weighs 2lbs. 9oz., displays a blue tint to his skin, his nostrils flare upon inhalation, and you notice retraction of the chest below the costal margin. Over a period of several hours you have noticed that he has become increasingly cyanotic, and has begun grunting during expiration, his heart rate is 200 bpm, and his pO2 is 40mm Hg.

This baby exhibits symptoms of:

A. Newborn JaundiceB. MacrosomiaC. NeglectD. Respiratory Distress SyndromeE. Acute Respiratory Distress Syndrome

Respiratory Distress Syndrome

Chi Chi EverhartEli GussenSelciya LamechKudakwashe MupepiTatend MupepiAkeem Oseni

Acute Respiratory Distress Syndrome (ARDS)

Acute respiratory distress syndrome (ARDS) is the sudden failure of the respiratory (breathing) system.

Develops in anyone over the age of 1 who is critically ill.

A person with ARDS has rapid breathing, difficulty getting enough air into the lungs and low blood oxygen levels.

ARDS usually develops in people who are already very ill with another disease or who have major injuries.

What is Respiratory Distress Syndrome (RDS)? Breathing disorder that affects premature

infants born ~6 weeks or more before their due dates

Deficiency of pulmonary surfactant in the infant’s immature lungs

Also known as Hyaline membrane disease, Neonatal (infant) respiratory distress syndrome

Phases of Lung Development

Pseudoglandular Stage(6 to 16 weeks)

Canalicular Stage (16 to 26 weeks)

Saccular (Terminal Sac) Stage (26 Weeks to Birth)

Alveolar stage (32 weeks to 8 years)

Secondary septation occurs Terminal sacs are

partitioned by secondary septa to form adult alveoli.

Surfactant

Complex lipoprotein Composed of 6

phospholipids and 4 apoproteins

70-80% phospholipids, 8-10% protein, and 10% neutral lipids

Reduces Surface tension

Risk Factors Premature delivery (Before 32 weeks)

Maternal diabetes (insulin dependent mother)

Infants delivered via caesarean section without maternal labor.

Family history of IRDS

Signs and Symptoms Cyanosis (bluish skin)

Retraction of the chest below and between the ribs with each breath

Grunting upon expiration

Flared Nostrils

Diagnostic tests Chest X-Ray Blood Test Echocardiography

Normal Lung

Treatment• Surfactant

replacement therapy

• High Frequency Ventilation

• Betamethasone – A corticosteroid

Differential diagnosis

Transient Tachypnea of the Newborn Excessive build of Fluid in the lungs

Pneumothorax Excessive air within alveoli

Pneumonia Bacterial or viral infection within the lungs

Prognosis Multiple organ failure from Long term

complications of lack of oxygen High pressure and demand will cause

inflammation in lungs resulting in lung damage

Brain damage – Germinal matrix hemorrhage

Death

Overview Little or no surfactant due to premature infant’s

underdeveloped lungs—arrested development during terminal sac stage.

Severe difficulty breathing due to lungs’ inability to remain patent.

May result in: cyanosis, low pO2, increased heart rate, increased respiratory rate, grunting during expiration, flaring of nostrils, and chest wall retraction.

Treatment: Early prenatal care, Administration of corticosteroids to mother for several days before birth (Preventive). May be intrauterine, or intra-amniotic. After birth, artificial surfactant injected directly into infant’s windpipe and high frequency ventilation can provide relief.

References About Kids Health. Diagnosis of Respiratory Distress

Syndrome.http://www.aboutkidshealth.ca/en/resourcecentres/prematurebabies/understandingdiagnosis/diagnosisofbreathingproblems/pages/diagnosis-of-respiratory-distress-syndrome.aspx. October 2009

Centers for Disease Control and Prevention . National Center for Health Statistics . VitalStats . Available at http://www .cdc .gov/nchs/VitalStats .htm . Accessed January 7, 2008 .

Jobe AH. Why Surfactant Works for Respiratory Distress Syndrome. NeoReviews. 2006; 7: 95-106.

Kopelman, Arthur, MD. RDS, The Merck Manual, 2009 Retrieved from: http://www.merckmanuals.com/home/childrens_health_issues/problems_in_newborns/respiratory_distress_syndrome.html

National Heart, Lung, and Blood Institute. How is Respiratory Distress Syndrome Diagnosed? http://www.nhlbi.nih.gov/health/health-topics/topics/rds/diagnosis. January 24, 2012

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

The Merck Manual. Respiratory distress syndrome. http://www.merckmanuals.com/professional/pediatrics/respiratory_disorders_in_neonates/respiratory_distress_syndrome.html

Warren JB, Andersen JM. Respiratory distress syndrome. Neoreviews. 2009; 7: 351-361.