Respiratory Distress Syndrome, Neonatal (NRDS)

BASICS

Definition: Disorder of prematurity, manifesting as respiratory distress due to surfactant deficiency (also called hyaline membrane disease).
Systems affected: Respiratory.
Synonyms: Hyaline membrane disease, surfactant deficiency.
Alert: Disorder of the neonatal period.

Mechanism: Impaired surfactant synthesis/secretion, usually due to immature lungs.
Results in: Low compliance, low lung volume, increased resistance.
Treatment-related injury: High O₂ exposure and barotrauma may further damage alveoli.
Genetics: No known genetic pattern.

Primary: Prevent premature birth (education, prenatal care, control maternal disease, healthy pregnancy behaviors)
Antenatal corticosteroids:
For 24–31 6/7 weeks: decreases risk if given 2–7 days before delivery.
Recommended for women at risk for preterm birth 24–33 6/7 weeks.

Preterm neonates: respiratory distress at/soon after birth, progressing over hours.
Early interventions modify classic course.

ABG: Respiratory/metabolic acidosis, hypoxemia, hypercarbia
CXR: Microatelectasis, diffuse reticulogranular (ground-glass) pattern, air bronchograms, low lung volumes
Others: CBC, blood culture, blood glucose
Echocardiogram: If murmur, to evaluate PDA
Pathology: Atelectasis, hyaline membranes

Delivery Room:
Delayed cord clamping if possible
Optimal thermoregulation
Respiratory Support:
No failure: early CPAP
Respiratory failure: intubate, ventilate, give surfactant
Monitoring:
Noninvasive: transcutaneous or end-tidal CO₂, pulse oximetry (target 90–94%)
Invasive: umbilical artery catheter, ABG
Antibiotics: Ampicillin + gentamicin pending cultures
Supportive: Thermoneutral environment, maintain perfusion, optimize fluids/electrolytes (avoid overhydration), nutrition. No routine diuretics.

Pulmonary Surfactant:
Poractant alfa (Curosurf), calfactant (Infasurf), beractant (Survanta)
Administer within 30–60 minutes of life, especially if <30 weeks or needing intubation
LISA (Less Invasive Surfactant Administration) preferred for spontaneously breathing infants on CPAP
Side effects: bradycardia, hypotension, airway obstruction, rapid tidal volume change (pneumothorax risk), pulmonary hemorrhage
Contraindicated in lethal anomalies, proven lung maturity
Caffeine: Early therapy may improve respiratory effort/neurodevelopmental outcomes in low-birth-weight infants requiring ventilation.
INO: Only for proven pulmonary hypertension/severe distress.
No routine diuretics.

All neonates with respiratory distress: evaluate/treat in delivery room, transfer to NICU
Supportive care, respiratory monitoring, family support/education
Discharge: Stable vitals and O₂ saturation, follow-up in place