Respiratory Distress Syndrome
(previously Hyaline Membrane Disease)
See Prematurity
Etiology
Low surfactant > poor lung complicance > impaired ability of compliant chest to transmit neg pressure > atelectasis
Prevention:
Antenatal steroids between 24-34w (reduce RDS and IVH)
prophylactic / early rescue Surfactant
HFOV and NO
Steroids
Treatment:
- Surfactant (Curosurf)
- MIST (Minimally invasive surfactant therapy)
- ? with long adult PIVC
- I+V
Complications
Bronchopulmonary dysplasia (aka Chronic neonatal lung disease)
Complications
See Prematurity
Etiology
- Surfactant deficiency
- 70% of <28/40, rare in term
- Risk factors: maternal diabetes, multiple births, LSCS, precipitous delivery, asphyxia, cold stress, affected (Mat) siblings, white, male
- Reduced in hypertension, maternal heroin use, prolonged ROM, and antenatal corticosteroid prophylaxis.
Low surfactant > poor lung complicance > impaired ability of compliant chest to transmit neg pressure > atelectasis
Prevention:
Antenatal steroids between 24-34w (reduce RDS and IVH)
prophylactic / early rescue Surfactant
HFOV and NO
Steroids
Treatment:
- Surfactant (Curosurf)
- MIST (Minimally invasive surfactant therapy)
- ? with long adult PIVC
- I+V
Complications
Bronchopulmonary dysplasia (aka Chronic neonatal lung disease)
- Lung injury secondary to atelectotrauma (RDS) barotrauma (Vent) and oxygen (free radicals)
- i.e. not present at birth, develops within weeks
- Affects bronchioalveolar development and vascular development
- 28d or more of O2 Rx
- Severity assessed which every is first 36/40 or DC (if <32/40 best) OR 28-56d or DC (>32/40)
- Mild: no Oxygen
- Mod: 22-30%FiO2
- Severe: >30% FiO2
Complications
- Asthma-like episodes to viral illnesses