Respiratory Diseases
Respiratory Diseases
Respiratory Diseases
ABEDULRAHMAN SHARIF, MD
• It occurs in
• 60-80% of infants <28 wk of gestational age,
• 15-30% of those between 32 and 36 wk of gestational age,
• rarely in those >37 wk of gestational age.
INCIDENCE
The risk for development of The risk of RDS is
RDS increases with reduced in
1. Maternal diabetes, 1. Pregnancies with chronic
2. Multiple births, or pregnancy-associated
3. Cesarean delivery, hypertension,
4. Precipitous delivery, 2. Maternal heroin use,
5. Asphyxia or hypoxemia 3. Prolonged rupture of
6. Cold stress or hypothermia membranes,
7. Hypovolemia and 4. Antenatal corticosteroid
hypotension prophylaxis
8. Maternal history of
previously affected infants.
ETIOLOGY AND PATHOPHYSIOLOGY
• Surfactant deficiency (decreased production and secretion; increased
consumption) is the primary cause of RDS.
•Normal
Lecithin : Sphingomyeline ratio is
>=2 which indicates mature lungs.
• Function of lung surfactant
1. Decreases surface tension during expiration
2. Allows the alveolus to remain partly expanded
3. Maintains functional residual capacity
ETIOLOGY AND PATHOPHYSIOLOGY
• Alveolar atelectasis, hyaline membrane formation, and interstitial edema make the
lungs less compliant in RDS, so greater pressure is required to expand the
alveoli and small airways due to increased surface tension.
• Thus, at end-expiration, the volume of the thorax and lungs tends to approach
residual volume, and atelectasis may develop. Results in perfused but not
ventilated alveoli, causing hypoxia.
• In most cases, the peak within 3 days, after which improvement is gradual.
5. finally death can result from severe impairment of gas exchange, alveolar air
leaks (interstitial emphysema, pneumothorax), pulmonary hemorrhage, or
IVH.
• Steroids are recommended for all women in preterm labor who are likely to
deliver within 1 wk and are safe with no adverse effects.
• Betamethasone better than dexamethasone.
• Repeated dosing is given every 6-12 hr for a total of 2 to 4 doses, depending on the
preparation.
• Nutritional supplementation.
• Diuretic therapy(Furosemide).
COMPLICATIONS OF RESPIRATORY DISTRESS
SYNDROME AND INTENSIVE CARE
v Bronchopulmonary dysplasia (BPD) :
• In severe cases, retained fetal lung fluid may interfere with the
normal postnatal fall in PVR, resulting in persistent
pulmonary hypertension; a mild surfactant deficiency may be
present.
Transient Tachypnea of the Newborn
• Transient tachypnea is frequently a diagnosis of
exclusion.
• ECMO.
PROGNOSIS
• The mortality rate of meconium-stained infants is considerably
higher than that of non-stained infants.