Respiratory distress syndrome affects premature neonates, particularly before 32 weeks gestation.
Pathophysiology
Inadequate surfactant leads to high surface tension within alveoli. It is more difficult for the alveoli and lungs to expand, resulting in atelectasis (lung collapse). There is inadequate gaseous exchange, causing hypoxia, hypercapnia (high CO2) and respiratory distress.
Management
Chest x-ray shows a ground-glass appearance.
Corticosteroids (e.g., intramuscular betamethasone) given to mothers with suspected or confirmed preterm labour increase surfactant production and reduce the incidence and severity of respiratory distress syndrome.
Premature neonates may need:
- Endotracheal surfactant (artificial surfactant delivered into the lungs via an endotracheal tube)
- Supplementary oxygen to maintain oxygen saturations between 91-95% in preterm neonates
- Continuous positive airway pressure (CPAP) via a nasal mask to help keep the lungs inflated whilst breathing
- Intubation and ventilation to fully assist breathing if the respiratory distress is severe
Support with breathing is gradually stepped down as the baby develops and can maintain their breathing.
Complications
Short-term complications include:
- Pneumothorax
- Infection
- Apnoea
- Intraventricular haemorrhage
- Pulmonary haemorrhage
- Necrotising enterocolitis
Long-term complications include:
- Bronchopulmonary dysplasia
- Retinopathy of prematurity
- Neurological, hearing and visual impairment
Last updated May 2025
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