Respiratory distress syndrome
Updates to Article Attributes
Hyaline membrane disease also known as neonatal respiratory distress syndrome, lung disease of prematurity, or surfactant deficiency refers to lung pathology which results from insufficient production of surfactant.
Demographics and clinical presentation
The incidence is estimated at 6 per 1000 births 2. Respiratory distress presents in the first few hours of life in a premature baby. Symptoms include tachypnoea, expiratory grunting, nasal flaring. The infant may or may not be cyanosed. Substernal and intercostal retractions may be evident.
Risk factors include maternal diabetes, greater prematurity, prenatal asphyxia and multiple gestation.
Associated abnormalities are those that can occur in prematurity: intracranial haemorrhage, necrotising enterocolitis, patent ductus arteriosus, delayed developmental milestones, hypothermia and hypoglycaemia.
Pathophysiology
Immature type II pneumocytes cannot produce surfactant. The lack of surfactant lowers the surface tension in alveoli causing collapse. Patients have a decreased lecithin:sphingomyelin ratio. Damaged cells, necrotic cells, and mucus line the alveoli.
Radiographic features
Plain film - chest radiograph
- typically gives diffuse ground glass lungs with low volumes and a bell-shaped thorax
- often tends to be bilateral and symmetrical
- air bronchograms may be evident
-
hyperventilationhyperinflation (in a non ventilated patient) excludes the diagnosis. - radiographs may show
hyperventilationhyperinflation if the patient is intubated.
RDS can be safely excluded if the neonate has a normal chest X-ray at 6 hours after birth.
If treated with surfactant thereapy there may be asymmetric improvement.
Treatment
Exogenous surfactant administration. Supportive oxygen therapy.
Complications
Acute
- persistent patent ductus arteriosus (PDA) due to reduced oxygen stimulus
- barotrauma (from treatment)
- oxygen toxicity (from treatment)
- pulmonary haemorrhage (can also included in the differential diagnosis)
Chronic
- bronchopulmonary dysplasia
- pulmonary interstital emphysema
- recurrent pulmonary infection
- subglottic stenosis (from intubation)
Differential diagnosis
-<li>hyperventilation (in a non ventilated patient) excludes the diagnosis.</li>-<li>radiographs may show hyperventilation <em>if</em> the patient is intubated.</li>- +<li>hyperinflation (in a non ventilated patient) excludes the diagnosis.</li>
- +<li>radiographs may show hyperinflation <em>if</em> the patient is intubated.</li>
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