Respiratory Distress Syndrome 1

RESPIRATORY DISTRESS
SYNDROME
WALDEMAR A. CARLO AND NAMASIVAYAM AMBALAVANAN
CHAPTER 101.1
NELSON’S TEXTBOOK OF PEDIATRICS 20TH EDITION
PP.850-858
BARRERA, RONNEL QUILO-AN 7-2
SENIOR CLERK
DECEMBER 12, 2017
OUTLINE
SLIDE 1.1.………. DEFINITION OF RDS
SLIDE 1.2……….. INCIDENCE
SLIDE 1.3……….. RISK FACTORS
SLIDE 1.4……….. ETIOLOGY
SLIDE 1.5……….. PATHOPHYSIOLOGY
SLIDE 1.6………...CLINICAL MANIFESTATION
SLIDE 1.7………...DIAGNOSIS
SLIDE 1.8………...PREVENTION
SLIDE 1.9………...TREATMENT
SLIDE 1.10………PHARMACOLOGIC THERAPIES
SLIDE 1.11……….COMPLICATIONS
SLIDE 1.12……….PROGNOSIS
1.1.) WHAT IS RESPIRATORY DISTRESS SYNDROME ?
A BREATHING DISORDER THAT AFFECTS NEWBORNS

ESPECIALLY PREMATURE INFANTS.
1.2.) INCIDENCE
• PREMATURE INFANTS
60-80% < 28 WEEKS AOG
15-30% BETWEEN 32 WEEKS TO 36 WEEKS AOG
RARE 37 WEEKS AOG
HIGHEST IN PRETERM MALE OR WHITE INFANTS
1.3.) RISK FACTORS
• MATERNAL DIABETES
• MULTIPLE BIRTHS
• CESAREAN DELIVERY
• PRECIPITOUS DELIVERY
• ASPHYXIA
• COLD STRESS
• MATERNAL HISTORY OF AFFECTED OF PREVIOUSLY AFFECTED
INFANTS
1.4.) ETIOLOGY
• SURFACTANT DEFICIENCY
* LECITHIN, PHOSPATIDYLGYCEROL, APOPROTEINS (SP-A,B,C,D), CHOLESTEROL
* A.) REDUCE SURFACE TENSION
B.) MAINTAIN ALVEOLAR STABILITY BY PREVENTING THE COLLAPSE OF AIR SPACES AT
END EXPIRATION
• 20 WEEKS AOG – HIGH FETAL LUNG
• 28 TO 32 WEEKS AOG – AMNIOTIC FLUID
• 35 WEEKS AOG AND UP – MATURE LEVELS OF PULMONARY SURFACTANTS
• SURFACTANT SYNTHESIS IS INFLUENCED BY:
* NORMAL PH, TEMPERATURE, PERFUSION
• SUPPRESSES:
* ASPHYXIA, HYPOXEMIA, PULMONARY ISCHEMIA W/ HYPOVOLEMIA,
HYPOTENSION, AND COLD STRESS
LUNGS LESS COMPLIANT:
*ALVEOLAR ATELECTASIS
* HYALINE MEMBRANE FORMATION
* INTERSTITIAL EDEMA
1.5.)Pathophysiology
SOURCE:
FROM FARRELL P, ZACHMAN R: PULMONARY SURFACTANT AND THE RESPIRATORY DISTRESS SYNDROME. IN QUILLIGAN EJ, KRETCHMER N, EDITORS: FETAL AND MATERNAL
MEDICINE, NEW YORK, 1980, WILEY. REPRINTED BY PERMISSION OF JOHN WILEY AND SONS, INC.)
Source: eMedicine Medscape
1.6.) CLINICAL MANIFESTATION
• RAPID, SHALLOW RESPIRATIONS IMMEDIATELY AFTER OR HRS AFTER BIRTH

• TACHYPNEA
• PROMINENT GRUNTING
• INTERCOSTAL AND SUBCOSTAL RETRACTIONS
• NASAL FLARRING
• CYANOSIS
• FINE CRACKLES
• UNTREATED
PROGRESSIVE WORSENING OF DYSPNEA AND CYANOSIS
BLOOD PRESSURE FALLS
CYANOSIS AND PALLOR INCREASES
GRUNTING DECREASES AS CONDITION WORSENS
MIXED RESPIRATORY METABOLIC ACIDOSIS
EDEMA
ILEUS
OLIGURIA
OMINOUS SIGN:
APNEA AND IRREGULAR RESPIRATIONS
IMPROVEMENT:
GRADUAL
SPONTANEOUS DIURESIS
IMPROVED BLOOD GAS VALUES
LOWER VENTILATOR SUPPORT
• DEATH:
SEVERE IMPAIRMENT OF GAS EXCHANGE
ALVEOLAR LEAKS (INTERSTITIAL EMPHYSEMA, PNEUMOTHORAX)
PULMONARY HEMORRHAGE
INTRAVENTRICULAR HEMORRHAGE
1.7.) DIAGNOSIS
• CHEST X RAY
• BLOOD GAS
• ACID BASE VALUES
CHEST X RAY:
RETICULAR GRANULARITY OF THE PARENCHYMA AND AIR
BRONCHOGRAMS,
MORE PROMINENT EARLY IN THE LOWER LOBE
DIFFERENTIAL DIAGNOSIS:
EARLY ONSET SEPSIS
PNEUMONIA
CYANOTIC HEART DISEASE
1.8.) PREVENTION
• AVOIDANCE OF POORLY TIMED EARLY CESAREAN SECTION (<39 WK) INDUCTION OF LABOR
• APPROPRIATE MANAGEMENT OF HIGH-RISK PREGNANCY AND LABOR (ADMINISTRATION OF
ANTENATAL CORTICOSTEROIDS)
• PREDICTION OF PULMONARY IMMATURITY
• ANTENATAL AND INTRAPARTUM FETAL MONITORING
• ANTENATAL CORTICOSTEROIDS TO WOMEN BEFORE 34 WK OF GESTATION
ANTENATAL STEROIDS
(1) OVERALL MORTALITY

(2) THE NEED FOR AND DURATION OF VENTILATORY SUPPORT AND
ADMISSION TO A NEONATAL
ICU
(3) THE INCIDENCE OF SEVERE IVH, NECROTIZING ENTEROCOLITIS, AND
NEURODEVELOPMENTAL
IMPAIRMENT.
• ADMINISTRATION OF SURFACTANT INTO THE TRACHEA OF
SYMPTOMATIC PREMATURE INFANTS IMMEDIATELY A ER BIRTH
(PROPHYLACTIC) OR DURING THE 1ST FEW HR OF LIFE (EARLY
RESCUE)
• CPAP STARTED AT BIRTH IS AS ELECTIVE AS PROPHYLACTIC OR
EARLY SURFACTANT AND IS THE APPROACH OF CHOICE FOR THE
DELIVERY ROOM MANAGEMENT OF A PRETERM NEONATE AT RISK
FOR RDS.
1.9.) TREATMENT
• EARLY SUPPORTIVE CARE OF PREMATURE INFANTS

• FREQUENT MONITORING OF HEART AND RESPIRATORY RATES, OXYGEN
SATURATION, PAO2, PACO2, PH, SERUM BICARBONATE, ELECTROLYTES,
GLUCOSE, HEMATOCRIT, BLOOD PRESSURE, AND TEMPERATURE.
• ARTERIAL CATHETERIZATION IS FREQUENTLY NECESSARY
• CPAP
• INCUBATOR OR RADIANT WARMER
• WARM, HUMIDIFIED OXYGEN BETWEEN 50 AND 70 MM HG (91-
95% SATURATION)
• ASSISTED MECHANICAL VENTILATION
• OXYGENATION
• CARBON DIOXIDE ELIMINATION
• HI FREQUENCY VENTILATION
1.10.) PHARMACOLOGIC THERAPIES
• SYSTEMIC CORTICOSTEROIDS
• INHALED NITRIC OXIDE
• SODIUM BICARBONATE, 1-2 MEQ/KG OVER 15-20 MIN THROUGH
A PERIPHERAL OR UMBILICAL VEIN, FOLLOWED BY ACID–BASE
DETERMINATION WITHIN 30 MIN FOR METABOLIC ACIDOSIS
• DOPAMINE IS MORE EFECTIVE IN RAISING BLOOD PRESSURE THAN
DOBUTAMINE
• EMPIRICAL ANTIBIOTIC THERAPY (PENICILLIN OR AMPICILLIN WITH
AMINOGLYCOSIDE)
• INTRAVENOUS HYDROCORTISONE AT 1-2 MG/KG/DOSE Q 6-12
HR
1.11.) COMPLICATIONS
TRACHEAL INTUBATION:
• PNEUMOTHORAX AND OTHER AIR LEAKS,
• ASPHYXIA FROM OBSTRUCTION OR DISLODGMENT OF TUBE
• BRADYCARDIA DURING INTUBATION OR SUCTIONING
• SUBSEQUENT DEVELOPMENT OF SUBGLOTTIC STENOSIS.
OTHER COMPLICATIONS
• BLEEDING FROM TRAUMA DURING INTUBATION
• POSTERIOR PHARYNGEAL PSEUDODIVERTICULA
• NEED FOR TRACHEOSTOMY
• ULCERATION OF THE NARES CAUSED BY PRESSURE FROM THE TUBE
• PERMANENT NARROWING OF THE NOSTRIL
• EROSION OF THE PALATE,
• AVULSION OF A VOCAL CORD,
• LARYNGEAL ULCER
• PAPILLOMA OF A VOCAL CORD
• ERSISTENT HOARSENESS, STRIDOR, OR EDEMA OF THE LARYNX.
• UMBILICAL ARTERIAL CATHETERIZATION
*EMBOLIZATION, THROMBOSIS, SPASM, AND VASCULAR
PERFORATION
• RENO- VASCULAR HYPERTENSION
• PATENT DUCTUS ARTERIOSUS
• BPD (BRONCHOPULMONARY DYSPLASIA)
BRONCHOPULMONARY DYSPLASIA
• BPD IS A DISEASE PRIMARILY OF INFANTS W/ BIRTHWEIGHT <1,000 G

• WHO WERE BORN AT <28 WK OF GESTATION
LUNG HISTOLOGY:
* ALVEOLAR HYPOPLASIA
* VARIABLE SACCULAR WALL FIBROSIS
* MINIMAL AIRWAY DISEASE
1.12) PROGNOSIS
• ANTENATAL STEROIDS, POST- NATAL SURFACTANT USE, AND

IMPROVED MODES OF VENTILATION HAVE RESULTED IN LOW
MORTALITY FROM RDS (=10%)
• OUTLOOK IS MUCH BETTER FOR THOSE WEIGHING >1,500 G.
• LONG-TERM PROGNOSIS FOR NORMAL PULMONARY FUNCTION IN
MOST INFANTS SURVIVING RDS IS EXCELLENT
• POOR PROGNOSTIC SIGNS :
PROLONGED VENTILATION, IVH, PULMONARY HYPERTENSION,
COR PULMONALE, AND OXYGEN DEPENDENCE BEYOND 1 YR OF
LIFE.
• PULMONARY FUNCTION SLOWLY IMPROVES IN MOST SURVIVORS
OWING TO CONTINUED LUNG AND AIRWAY GROWTH AND
HEALING.
• GRADUAL DECREASE IN SYMPTOM FREQUENCY IN CHILDREN AGES
6-9 YR FROM THE FREQUENCY DURING THE 1ST 2 YR OF LIFE.
THANK YOU
AND
GOD BLESS!

Respiratory Distress Syndrome 1

Uploaded by

Document Information

Original Description:

Copyright

Available Formats

Share this document

Share or Embed Document

Sharing Options

Did you find this document useful?

Is this content inappropriate?

Copyright:

Available Formats

Respiratory Distress Syndrome 1

Uploaded by

Copyright:

Available Formats

RESPIRATORY DISTRESS

A BREATHING DISORDER THAT AFFECTS NEWBORNS

• RAPID, SHALLOW RESPIRATIONS IMMEDIATELY AFTER OR HRS AFTER BIRTH

(1) OVERALL MORTALITY

• EARLY SUPPORTIVE CARE OF PREMATURE INFANTS

• BPD IS A DISEASE PRIMARILY OF INFANTS W/ BIRTHWEIGHT <1,000 G

• ANTENATAL STEROIDS, POST- NATAL SURFACTANT USE, AND

You might also like