This document provides information about respiratory distress syndrome in neonates. It defines respiratory distress syndrome and lists its causes as prematurity, maternal diabetes, meconium aspiration syndrome, caesarean section, and pulmonary or non-pulmonary issues. The clinical features, diagnostic measures, management including oxygen therapy, ventilation support, nutrition, and nursing care are described. The prognosis is generally good with timely treatment but complications can include patent ductus arteriosus and bronchopulmonary dysplasia.

1. Prepared by:
Shraddha Dahal
Roll no :25
B.Sc. Nursing 4th year

2. General Objective
At the end of this session, all the B.Sc.
Nursing 3rd year students will be able to
explain about respiratory distress syndrome
in neonate.

3. Specific Objectives
At the end of this session, all the B.Sc.
nursing 3rd year students will be able to:
• define respiratory distress syndrome.
• state the prevalence of respiratory distress
syndrome.
• list out the causes of respiratory distress
syndrome.
• describe the pathogenesis of respiratory
distress syndrome.

4. • list out the clinical features of respiratory
distress syndrome.
• identify diagnostic measures of respiratory
distress syndrome.
• describe the management of respiratory
distress syndrome.
• explain nursing management of respiratory
distress syndrome.
• identify the prognosis of respiratory distress
syndrome.
• list out the complications of respiratory
distress syndrome.

5. Respiratory Distress Syndrome
• Respiratory distress syndrome (RDS),
formerly known as hyaline membrane
disease, is life threatening lung disorder that
result from underdeveloped and small alveoli
and insufficient level of pulmonary surfactant
that leads to atelectasis.
• Respiratory distress is leading cause of death
in preterm infants.
• It occurs in 50% babies born at 26 to 28
weeks and 25% of babies born at 30-
31weeks.

7. Causes
• Prematurity (more common)
• Maternal diabetes
• Meconium aspiration syndrome
• Caesarean section
• Pulmonary causes: Congenital malformation
,pneumonia , Pleural effusion , edema of
lungs , bleeding from lungs
• Non pulmonary causes: Sepsis, exposure to
cold, acute blood loss

8. Pathogenesis

10. Clinical Features
A) Initial manifestation
• Tachypnea and labored breathing
• Audible expiratory grunting
• Intercoastal / substernal retractions
• Nasal flaring
• Cyanosis or pallor
• Fine respiratory crackles

11. ……contd
B) Manifestations as disease progresses
• Apnea
• Flaccidity
• Unresponsiveness
• Diminished breath sound
• Mottling

12. Mottling

13. .…contd
C) In severe condition
• Shock like state
• X- ray shows reticulogranular pattern
known as ground glass appearance of
lung fields that represents alveolar
atelectasis.

14. Ground Glass Appearance

15. Diagnostic Measures
• Details of antenatal and prenatal history.
• Assessment and evaluation of clinical
manifestations.
• Arterial blood gas analysis:
 PCO2 above 65mm of Hg
 PO2 of 40mm of Hg
 PH below 7.15

16. ….contd
• X- ray shows ground glass appearance of
lung fields that represents alveolar
atelectasis.
• Pulse oxymetry : decrease SPO2.
• Shake test
• Prenatal diagnosis of RDS can be made
by determining lecithin / sphingomyelin
ratio in amniotic fluid after 35 weeks of
gestation.

17. Management
• Neonate should be placed in intensive
care unit and nursed in a warm incubator.
The infant must be kept warm (at around
36.50C).
• Oxygen administration
Adequate warm and humidified O2 in high
concentrationis given through plastic hood
to maintain arterial PO2 between 50-90
mm of Hg is given.

18. ….contd
If oxygen saturation of blood cannot
maintained at a satisfactory level and
carbon dioxide level rises , infant will
required ventilator support.
Mild distress can be managed without
ventilator. Moderate and severe RDS
needs ventilator support.
Frequently monitoring of the PO2 , PCO2 ,
pH , and arterial blood gas are to be done
to diagnosis metabolic and respiratory
acidosis.

19. ….contd
• Ventilator support:
Infants with RDS are handicapped by
decrease lung compliance and alveolar
collapse during expiration. Administration
of oxygen under positive pressure would
prevent if alveolar collapse and ensure
gas exchange throughout the respiratory
cycle.
Continuous positive airway pressure is
indicated and useful in infant with
decrease lungs compliance .

22. ….contd
If despite of CPAP ,arterial PO2 remains
below 50mm of Hg or PCO2 is greater than
50 mm of Hg and PH can't be corrected then
assisted ventilation with positive end
expiratory pressure is required.
On recovery , the infant is gradually weaned
to synchronised intermittent mandatory
(SIMV)mode followed by CPAP.
After weaning from ventilator ,oxygen should
be administered via hood.

23. ….contd
• Maintenance of nutrition and hydration
by IV route.
• Maintenance of acid base balance.
Intravenous administration of sodium
bicarbonate 7.5% sodium bicarbonate in
dose of 3-8 meq/kg in 24 hours in 1:1
dilution with distilled water.

24. • Surfactant therapy
Surfactant is indicated in all
neonate with RDS.
Adequate oxygenation , ventilation
and monitoring should be started
before administration surfactant.
Dose - 100mg/kg body weight in
2-4 divided doses at 6-12 hrs
apart .
Depending upon the baby’s
condition, repeated dose of
surfactant need to be
administered.

25. …contd
 The therapy leads to improved oxygenation and
reduction in oxygen dose required by patient.
 A blood gas should be checked within 15 - 20
minutes of the dose and the ventilator settings
should be weaned appropriately to minimize the
risk of a pneumothorax. A chest radiograph should
be checked both 1 hour and 4 - 6 hours after the
initial dose to avoid hyperinflation.
 The adverse effect of surfactant therapy include
apnea, hypotension , pulmonary hemorrhage and
bradycardia, lung tissue damage from oxygen
pressure.

26. ….contd
• IV antibiotics
• Administration of vitamin E
low birth weight or preterm babies
receiving O2 therapy may be administered
vitamin E in dose of 100IU /kg/day IM from
birth onwards.

27. Nursing Management
• Assessment
• Nursing diagnosis
 Ineffective breathing pattern related to surfactant
deficiency , alveolar instability.
 Impaired gas exchange related to immature
pulmonary function.
 Risk of injury (brain injury) related to hypoxemia.
 Ineffective thermoregulation related to immature
temperature regulation mechanism.
 Risk of infection related to deficient immunological
defence .

28. ….contd
• Nursing interventions
 Maintain airway and administer oxygen.
 The patient should be kept with the head elevated
to reduce pressure on diaphragm.
 Endotracheal suctioning can be done as required
using strict aseptic techniques. Monitor oxygen
saturation while suctioning (not more than 5
seconds) the baby.
 Assess the respiratory rate and general status of
the neonate , O2 saturation, respiratory pattern ,
arterial blood gas and vital signs.

29. …contd
Maintain neutral thermal environment.
 Preterm with respiratory distress syndrome
should be prevented from infection by
minimal handling and using aseptic technique
while handling.
 Skin care with use of water pillows, change
of napkin if wet,clean skin folds with sterile
swab and with frequent position change.
Provide necessary care to neonate in
incubator and ventilator as per requirements.

30. Prognosis
• Prognosis is good with appropriate and timely
treatment.
• Survival can be as 60 -80% in infant >1000gm.
• In the absence of ventilatory support neonate
with severe disease will die.
• If there is no complication during 48 hours ,
infant begins to improve by 72 hours and if
survive for 96 hours, chance of survival is
high.

31. Complications
• Patient ductus arterious
• Congestive cardiac failure
• Retrolental fibroplasia
• Intraventricular hemorrhage
• Bronchopulmonary dysplasia
• Neurological abnormalities

33. References
• Subedi, D.,& Gautam ,S.(2017) .Midwifery nursing part III
( 3rd ed.). Medhavi Publication ,Baneshwor,
Kathmandu,Nepal (pp:257-260).
• Shrestha ,T.(2016).Essential child health nursing( 2nd ed.).
Apex Press Tinkune , Kathmandu,Nepal (pp:196-198).
• Adhikari,T. (2015) .Essentials of pediatric nursing (2nd ed.).
Vidhyarthi Pustak Bhandar, Kathmandu,Nepal ( pp:53-55).
• Sharma,R. (2013). Essential Paediatrics for Nurses( 2nd
ed.). Jyapee Brothers Medical Publisher , New Delhi,India(
pp:217-22).

34. …contd
• Hocken., & Berry , J.M. (2011) , WONG’S Nursing
care of infant and children’s (9th ed.). Libery of
congress catologinia publication , United states of
America (pp:347-354).
• Sing, M. (2008) , Essential paediatrics for nurses (2nd
ed.).CBS Publisher and Distributors , Daryaganj , New
Delhi,India( pp:48-50).
• Lipincott, W .W. (2007), Maternal and child health
nursing care of child bearing and child rearing
women(5th ed.). Libery of congress catologinia
publication , United states of America (pp:777-784).

35. …contd
• Thakur, L .(2012).Advanced child health nursing (3rd
ed.).Ultimate Marketing ,Lazimpat ,Kathmandu,Nepal
(pp: 77-79).
• Tuitui,R .(2007). Manul of midwifery C(4th
ed.).Vidyarthi Pustak Bhandar Publication, Bhotahity
,Kathmandu ,Nepal(pp :179-182).
• Robert ,N.R.C. (1988).Textbook of neonatology (1st
ed.).Libery of Congress Cataloguing Publication ,
Singapoor( pp:274-306).
• Durham ,R., & Cmapmam ,L Maternal newborn
nursing(2nd ed.) .Jyapee Brothers Medical Publisher,
New Delhi, India( pp:108-112).