This presentation consists of Respiratory distress syndrome in newborn.

1. Prepared by:
Prabita Shrestha

2.  Respiratory distress syndrome is one of the
danger sign of the new born.
 It almost always occurs in preterm babies.
 The overall incidence is 10-15% but can be as
high as 80% in neonates < 28 weeks.
 In addition to prematurity, asphyxia, acidosis,
maternal diabetes and cesarean section baby
and breech delivery can increase the risk of
developing RDS.

3.  Infant respiratory distress syndrome (IRDS), also
called neonatal respiratory distress syndrome,
respiratory distress syndrome of newborn, or
increasingly surfactant deficiency disorder (SDD),
and previously called hyaline membrane disease
(HMD), is a syndrome in premature infants caused by
developmental insufficiency of surfactant production
and structural immaturity in the lungs.
 Increased alveolar fluid content, inadequate clearance
of lung fluid, lack or inhibition of surfactant function,
or reduced surface area for gas exchange is the basic
pathology for respiratory distress.

4. 1. PULMONARY:
 Hyaline membrane disease (HMD)
 Meconium aspiration
 Pulmonary hypoplasia
 Broncho-pulmonary dysplasia
 Broncho-pneumonia
 Airway obstruction
 Transient tachypnea
 Pneumothorax
 Pulmonary edema

5. 2. CARDIOVASCULAR:
 Congenital heart disease
i. Aortic stenosis
ii. Coarctation of aorta
iii. Cyanotic –Transposition of great vessels
 Heart failure
 Persistent pulmonary hypertension of
newborn (PPHN)

6. 3. NON-CARDIOPULMONARY:
 Metabolic acidosis
 Hypoglycemia
 Hypo / hyperthermia
 Asphyxia
 Drugs (pethidine)
 Birth trauma
 Intracranial injury

7.  Prematurity
 Maternal diabetes
 Multiple births
 Elective cesarean section without labor
 Perinatal asphyxia
 Cold stress
 Sepsis
 Metabolic acidosis
 Genetic disorders

8.  In RDS, the basic abnormality is surfactant
deficiency. It is lipoprotein containing
phospholipids produced by alveolar cells,
which helps to reduce surface tension in the
alveoli.

9. Normal Expiration
With Surfactant
Surfactant Function
Abnormal Respiration
Without Surfactant

10. • In the absence of sufactant, surface tension increases and alveoli
collapse during expiration.
• During inspiration, more negative pressure is needed to keep
alveoli patent
• There is inadequate oxygenation and increased work of
breathing.
• Hypoxemia and acidosis results in pulmonary vasoconstriction
• It further leads to right to left shunting across the foramen ovale
• This worsens the hupoxia and leads to respiratory failure

11.  Cyanosis
 Apnea
 Decreased urine output
 Grunting
 Nasal flaring
 Tachypnea upto 80 – 100 breathes/min
 Dyspnea
 Fine respiratory crackles
 Pronounced intercoastals / substernal retraction
 Flacidity
 Unresponsiveness
 Diminished breath sound
 Shock like state (in severe distress)

12.  Blood gas analysis -- shows low oxygen and
excess acid in the body fluids
 Chest x-ray -- shows a "ground glass"
appearance to the lungs that is typical of the
disease.This often develops 6 to 12 hours
after birth.
 Lab tests – rule out infection as a cause of
breathing problems
 Pulse oxymetry
 Pulmonary function test

13. 1. Taking steps to prevent premature birth can help
prevent neonatal RDS. Good prenatal care and
regular checkups beginning as soon as a woman
discovers she is pregnant can help avoid premature
birth.
2. The risk of RDS can also be lessened by the proper
timing of a Cesarean delivery if needed. A lab test can
be done before delivery to check the readiness of the
baby’s lungs. When possible, the delivery should be
delayed until tests show that the baby’s lungs have
matured.

14. 3. Medicines called corticosteroids may help speed up
lung maturity in the developing baby. They are often
given to pregnant women between 24 and 34 weeks
of pregnancy who seem likely to deliver in the next
week. At times it may be possible to give other
medicines to delay labor and delivery until the steroid
medication has time to work.
Antenatal corticosteroid therapy consists of
either:
 Betamethasone 12 mg/dose IM for 2 doses, 24 hrs
apart, or
 Dexamethasone 6 mg/dose IM for 4 doses, 12 hrs
apart

15. 4. Prevent fetal hypoxia in diabetic mothers.
5. Avoid premature induction of labor.
6. Suction immediately after birth to patent
the airway.
7. Early surfactant therapy: prophylactic use of
surfactant in preterm newborn <27 weeks'
gestation.

16.  Neonates suspected to have RDS needs to treat in
NICU.
 Administer oxygen and IV fluids.
 Mild distress can be managed without ventilator. If
respiratory distress is significant or is associated with
hypoxemia, hypercapnia or acidosis, the infant need
ventilator support.
 Administer surfactant therapy: early rescue therapy
within 2 hrs after birth is better than late rescue
treatment when the full picture of RDS is evident.

17.  Dosing may be
divided into 2
alliquots and
adminitered via
a 5-Fr catheter
passed in the
ET

18.  Antibiotics
 Amino glucosides pancuronium (musle
relaxant)
 Frusemide
 Bicarbonate

19.  Prognosis is good with appropriate and
timely treatment.
 The condition often gets worse for 2 to 4 days
after birth.
 It often improves slowly after that.
 Some infants with severe respiratory distress
syndrome will die.
 Survival can be high as 60-80 % in infants
>1000 gm.

20.  Septicemia
 Bronchopulmonary dysplasia (BPD)
 Patent ductus arteriosus (PDA)
 Pulmonary hemorrhage
 Apnea/bradycardia
 Necrotizing enterocolitis (NEC)
 Retinopathy of prematurity (ROP)
 Hypertension
 Failure to thrive
 Intraventricular hemorrhage (IVH)

21. 1. Dutta D. C. Textbook of Obstetrics, 6th Edition,
Page no. 474-477
2. Shrestha T. Essential Child Health Nursing, 1st
Edition, Page no. 115-118
3. Tuitui R. Mannual of Midwifery III, 8th Edition,
Page no. 223-227
4. http://emedicine.medscape.com/article/976034
-overview
5. https://en.wikipedia.org/wiki/Infant_respiratory
_distress_syndrome
6. https://www.nlm.nih.gov/medlineplus/ency/arti
cle/001563.htm