IRDS

• Respiratory distress syndrome


  Severe lung disorder in neonate primarily related to lung immaturity
• Respiratory distress syndrome


  • Responsible for more infants death and neurological complications
  • Syndrome of premature neonates characterized by progressive and usually fatal respiratory failure resulting from atelectasis and immaturity of lungs
  • Formerly known as Hyaline membrane disease
• Breathing rate


  Usually more than 60 breaths per min and/or use of accessory muscle of respiration which may be accompanied by grunting
• Surfactant production


  • Starts around 20 weeks of life and peaks at 35 weeks
  • Neonates less than 35 weeks are prone to develop RDS, without surfactant infants are unable to keep their lungs inflated
• Risk factors for RDS

  • Prematurity
  • Asphyxia
  • Hypothermia
  • Maternal Anaemia
  • Pre-eclampsia
  • Maternal diabetes
  • Caesarian section
• Pulmonary risk factors for RDS

  • Pneumonia
  • Pneumothorax
  • Congenital Malformation
  • Upper airway obstruction e.g. meconium aspiration syndrome
• Non-pulmonary risk factors for RDS

  • Sepsis
  • Cardiac defect
  • Exposure to cold
  • Hypoglycemia
  • Metabolic acidosis
  • Acute blood loss
• Surfactant


  Lipoprotein containing phospholipids produced by type II alveolar cells of lungs and helps to reduce surface tension in alveoli
• Surfactant deficiency in RDS

  1. During expiration, absence of surfactant increases surface tension and causes alveoli to collapse

  2. During inspiration, more negative pressure is needed to keep alveoli patent
• Surfactant deficiency in RDS

  Leads to inadequate oxygenation, increased work of breathing, hypoxemia and acidosis
• Surfactant deficiency in RDS

  Causes pulmonary vasoconstriction and right to left shunting across foramen ovale, worsening hypoxia and respiratory failure
• Clinical manifestations of RDS

  • Tachypnea
  • Dyspnea
  • Pronounced intercostals or substernal retractions
  • Fine inspiratory crackles
  • Audible expiratory grunt
  • Flaring of external nares
  • Cyanosis or pallor
• Manifestations as RDS progresses

  • Apnea
  • Flaccidity
  • Absent spontaneous movement
  • Unresponsiveness
  • Diminished breath sound
  • Mottling
  • Shock like state in severe condition
• Diagnostic tests for RDS

  • History taking
  • Physical examination
  • Chest x-ray: ground glass appearance
  • ABG
  • Pulse oxymetry
  • Pulmonary function test
  • Shake test
  • Downe's score
• Shake test


  It can be done on the gastric aspirate to determine lung maturity. Formation of bubbles indicates adequate surfactant and less chance of RDS.
• Medical management of RDS

  1. Administer IV fluids and oxygen

  2. Start oxygen therapy at 4-6 lit/min, maintain oxygen saturation between 90-95%

  3. Administration of exogenous surfactant through ET tube directly into trachea
• Medications used in RDS

  • Antibiotics: aminoglycosides, amoxicillin, ampicillin, cotrimoxazole and procaine penicillin
  • Muscle relaxants: pancuronium
  • Diuretics: furosemide
  • Antacids: sodium bicarbonate, sodium citrate
  • Indomathacin: if patent ductus arteriosus
• Supportive management in RDS

  • Maintain adequate hydration and electrolyte status
  • Administer anti pyretics to reduce fever
  • Maintain acid base balance
  • No nipple or gavage feeding: increase respiratory rate and chance of aspiration
  • IV line for fluid/hydration, nutrition and medication
• Assessment in RDS


  • History taking
  • Physical examination
  • Downe's score
  • Shake test
• Respiratory therapist diagnosis in RDS

  • Ineffective breathing pattern related to surfactant deficiency and alveolar instability
  • Impaired gas exchange related to immature pulmonary function
  • Altered nutrition: less than body requirement related to feeding difficulties
  • Altered body temperature related to prematurity
  • Parental anxiety related to disease condition
  • Risk for injury (brain injury) related to hypoxemia
• Nursing interventions in RDS

  1. Assess pre-term infant for respiratory and general status: oxygen saturation, cyanosis, ABG, axillary temperature, respiratory pattern

  2. Maintain airway and administer oxygen at 4-6 lit/min

  3. Provide ventilatory support if needed

  4. Perform gentle chest percussion, vibration and postural drainage based on assessed need and infant tolerance

  5. Monitor for signs of hyperthermia and hypothermia

  6. Place the infant in radiant warmer, incubator and use environmental control to decrease heat loss

  7. Position the infant to facilitate open airway on the side with head supported

  8. Quick gentle suctioning as needed

  9. Maintain neutral thermal environment to decrease metabolic requirement and conserve oxygen utilization

  10. Maintain parenteral nutrition, avoid oral feeding or through tube if child is in distress

  11. Maintain optimal nutrition pattern, start NG feeding once baby is breathing without distress

  12. Involve parent in the care of children and allow frequent visit to encourage and promote infant – parent bonding

  13. Provide skin care with frequent position change, mouth care, psychological support and adequate information about child's condition
• Complications of RDS


  • Patent ductus arteriosus
  • Congestive cardiac failure
  • Intraventricular hemorrhage
  • Retinopathy of prematurity
  • Pneumonia
  • Sepsis
  • Necrotizing enterocolitis
  • Neurologic sequele