Respiratory Distress Syndrome (RDS), also known as neonatal respiratory distress syndrome, is a condition in premature infants caused by a lack of pulmonary surfactant and underdeveloped lungs. This puts premature infants at risk of breathing difficulties. Symptoms include rapid breathing, grunting, and cyanosis. Diagnosis involves blood gas and chest x-ray analysis. Treatment focuses on corticosteroids to aid lung development, surfactant replacement therapy, oxygen supplementation, and ventilation support. While treatment has reduced mortality by 50%, complications can still include sepsis, bronchopulmonary dysplasia, and intraventricular hemorrhage.

1. Respiratory Distress Syndrome
Rahul Dhaker
Asst. Professor ,
RCN , Bhilwara
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R Dhaker, Asst. Professor, RCN

2. OTHER NAME
• Infant respiratory distress syndrome (IRDS)
• Neonatal respiratory distress syndrome
• Respiratory distress syndrome of newborn
• Surfactant deficiency disorder (SDD)
• Hyaline membrane disease (HMD)
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5. Introduction
• It is a syndrome in premature infants caused by
– developmental insufficiency of pulmonary
surfactant production and structural immaturity in the lungs.
• It can also result from a genetic problem with the
production of surfactant associated proteins.
• IRDS affects about 1% of newborn infants and is the
leading cause of death in preterm infants.
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8. Cont… Introduction
• The incidence decreases with advancing gestational
age, from about 50% in babies born at 26–28 weeks,
to about 25% at 30–31 weeks.
• The syndrome is more frequent in infants of diabetic
mothers and in the second born of premature twins.
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9. Causes
• Neonatal RDS occurs in infants whose lungs have
not yet fully developed
• The disease is mainly caused by a lack of a
slippery substance in the lungs called surfactant
• Neonatal RDS can also be due to genetic
problems with lung development
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11. Cont…. Causes
• Other factors that can increase the risk of RDS
include:
– A brother or sister who had RDS
– Diabetes in the mother
– Cesarean delivery or induction of labor before the is full-
term
– Problems with delivery that reduce blood flow to the baby
– Multiple pregnancy (twins or more)
– Rapid labor
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14. Symptoms
• Most of the time symptoms appear within minutes of birth.
However, they may not be seen for several hours. Symptoms
may include:-
– Bluish color of the skin and mucus membranes (cyanosis)
– Brief stop in breathing (apnea)
– Decreased urine output
– Grunting
– Nasal flaring
– Rapid breathing
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16. Cont…Symptoms
– Shallow breathing
– Shortness of breath and grunting sounds while
breathing
– Unusual breathing movement (such as drawing
back of the chest muscles with breathing)
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Chest radiographs in a premature infant with respiratory distress
syndrome before and after surfactant treatment.
R Dhaker, Asst. Professor, RCN

20. Diagnostic Evaluation
• Blood gas analysis - shows low oxygen and
excess acid in the body fluids
• Chest x-ray
• Lab tests – rule out infection as a cause of
breathing problems
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22. Treatment
• Approach Considerations
– Corticosteroids
– Surfactant Replacement Therapy
– Oxygenation and CPAP
– Vapotherm
– Assisted Ventilation
– High-Frequency Ventilation
– Nitric Oxide
– Supportive Therapy
– Parent and Family Support
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23. Cont…Treatment
• placing an Endotracheal tube (breathing tube, also
called an ET) into windpipe
• mechanical breathing machine (to do the work of
breathing for your baby)
• supplemental oxygen (extra amounts of oxygen)
• continuous positive airway pressure (CPAP) - a
mechanical breathing machine that pushes a
continuous flow of air or oxygen to the airways to
help keep tiny air passages in the lungs open
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24. Cont…
• Extracorporeal membrane oxygenation
(ECMO)
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28. Corticosteroids
• corticosteroids reduces the risk of respiratory
distress syndrome and neonatal death.
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29. Surfactant Replacement Therapy
• The advent of surfactant therapy has reduced the
mortality rate from respiratory distress syndrome by
approximately 50%
– Premature neonates with surfactant deficiency and
respiratory distress syndrome have about 5mg/kg.
– Full-term animal models have about of 50-100mg/kg.
– Recommended dosages of clinically available surfactant
preparations are 50-200mg/kg, approximately the surfactant
of term newborn lungs.
• Most neonates require 2 doses; however, as many as 4
doses, given at 6-hour to 12-hour intervals,
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32. Complications
• The incidence and severity of complications of
respiratory distress syndrome can result in
clinically significant morbidities.
– Septicemia
– Bronchopulmonary dysplasia (BPD)
– Patent ductus arteriosus (PDA)
– Pulmonary hemorrhage
– Apnea/bradycardia
– Hypertension
– Failure to thrive
– Intraventricular hemorrhage (IVH)
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