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Updated: Mar 7 2023

Neonatal Respiratory Distress Syndrome

  • CXRPathophysiology
    • aka hyaline membrane disease
    • immature fetal lungs have a deficiency in surfactant 
    • reduced surfactant results in low lung compliance and subsequent atelectasis, intrapulmonary shunting, and acute lung injury
  • Causes
    • prematurity (most important)
      • type II pneumocytes not developed
        • normal source of surfactant production
    • Cesarean section
      • lack of vaginal compression stress on the infant during delivery results in reduced fetal cortisol production and resultant reduction in surfactant production
    • maternal diabetes 
      • high insulin levels decrease surfactant production
        • increased fetal blood glucose results in increased fetal insulin production
  • Symptoms
    • dyspnea, tachypnea during first hours of life
    • nasal flaring
    • expiratory grunting,
    • intercostal, subxiphoid retractions
  • Physical exam
    • severe hypoxemia 
      • not responsive to 100% O2
        • atelectasis results in intrapulmonary (right-to-left) shunting
          • perfusion without ventilation
  • ABG
    • hypoxemia
    • respiratory acidosis (elevated PCO2) from poor ventilation 
  • Histology 
    • hyaline membrane surrounds collapsed alveoli
  • CXR
    • "ground-glass" appearance 
  • Amniotic fluid  
    • lecithin:sphingomyelin ratio < 1.5 
  • Prevention 
    • corticosteroids given to mother between 23 and 34 weeks gestation at increased risk for preterm delivery within 7 days  
      • results in increased surfactant production 
  • Treatment
    • nasal CPAP
    • surfactant replacement (endotracheal, so intubation is needed) 
  • Bronchopulmonary dysplasia
    • still very common
  • Patent ductus arteriosus
    • normally closed by increased Otension at birth
      • hypoxia keeps shunt open
  • 100% O2 therapy damage
    • free radical damage of eyes and lungs
      • may result in blindness and pulmonary dysplasia 
    • damage also when the neonate is taken off oxygen therapy
      • upregulation of VEGF due to relative hypoxia results in neovascularization in the retina (retinopathy of prematurity)
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