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Neonatal Diseases RC 290 Respiratory Distress Syndrome(RDS) Also known as Hyaline Membrane Disease (HMD) Occurrence 1-2% of all births 10% of all premature births Greatest occurrence is in the premature and low birth weight infant Etiology Predisposing Factors Prematurity Immature lung architecture and surfactant deficiency Fetal asphyxia hypoxia Maternal diabetes Increased chance of premature birth Possible periods of reflex hypoglycemia in the fetus causing impaired surfactant production Pathophysiology Surfactant deficiency Decreased FRC Atelectasis Increased R-L shunt Increased W.O.B. Hypoxemia and eventually hypercapnia because of V/Q mismatch Pathophysiology (cont.) Atelectasis keeps PVR high Increased PAP Lung hypoperfusion R-L shunting may re-occur across the Ductus Arteriosus and the Foramen Ovale Hypoxia/hypoxemia results in anaerobic metabolism and lactic acidosis This damages the alveolar-capillary membrane causing formation of hyaline membranes. Hyaline membranes perpetuate all of the problems in the lung The cycle continues until surfactant levels are adequate to stabilize the lung Symptoms usually appear 2-6 hours after birth Why not immediately? Disease peaks at 48-72 hours Recovery usually occurs 5-7 days after birth Clinical findings: Physical Tachypnea (60 BPM or ) Retractions Nasal flaring Expiratory grunting Helps generate autoPEEP Decreased breath sounds with crackles Cyanosis on room air Hypothermia Hypotension Clinical Findings: Lab ABGs: initially respiratory alkalosis and hypoxemia that progresses to profound hypoxemia and combined acidosis Increased Bilirubin Hypoglycemia Possibly decreased hematocrit CXR: Normal RDS CXR: Ground Glass Effect RDS CXR: Air Bronchograms Hilar Densities Time constant is decreased since elastic resistance is so high Increased elastic resistance means decreased compliance! RDS Treatment: Primarily supportive until lung stabilizes NTE, maintain perfusion, maintain ventilation and oxyge