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What is Respiratory
Distress Syndrome?
Also called hyaline membrane disease, RDS
is the most common lung disease of premature infants. RDS
causes difficulty in breathing due to immaturity of the lungs
and to insufficient production of surfactant.
Who is affected?
RDS usually occurs in infants born before 32 weeks of pregnancy.
The more premature
the baby is, the greater is the chance of developing RDS and
it almost invariably occurs under 28 weeks gestation.
In addition to gestational age, the major predisposing factors
are: gender (boys more than girls); race (Caucasian); caesarean
delivery; asphyxia; maternal diabetes; multiple birth; hypothermia;
intrauterine growth retardation.
How is RDS treated?
The three most important strategy in prevention and treatment
of RDS are: a) antenatal administration of glucocorticoids,
such as betamethasone, to the mother for at least 24 hours
before delivery. These drugs induce fetal surfactant
production and usually reduce the risk of RDS or decrease
its severity; b) surfactant
replacement therapy. The use of exogenous surfactant
in preterm infants improves oxygenation, decreases air leaks
and reduces mortality due to RDS; c) respiratory support with
either continuous positive airway pressure (CPAP) or ventilation
with positive end-expiratory pressure (PEEP). Delivering oxygen
under pressure helps keep the air sacs open.
How long will the
infant be on the neonatal
intensive care unit?
For each baby the case is different. RDS
can get worse for about 3-4 days, and then the infants gradually
needs less added oxygen. Recovery is slower if: the birth
weight is very small, the baby’s disease is very severe,
infection or other complications, such as pneumothorax
and pulmonary
emphysema, exsist. In general the more preterm
the baby the longer they stay in hospital. This is because
their body systems particularly those that control breathing
need to mature. In general most babies go home around the
date they should have been born. Some will be home several
weeks earlier and a few weeks a little later.
What is surfactant?
The lung surfactant
is a lubricating liquid lining the lungs that works to enable
the lungs to expand easily.
How is the surfactant
given?
The surfactant
is given directly down the breathing tube (ET tube), so the
infant must be intubated to receive surfactant.
What tests will
normally be performed?
Frequent blood sampling is necessary to determine the right
amount of oxygen, water and nutrition etc. the baby requires
and can help decide if an infection is present. Chest X-ray
and pulmonary function studies can sometimes help in the management
of the baby’s lung disease. Other common tests include
retinopathy screening (an eye examination); which is performed
in babies born at less than 32 weeks or with a birth weight
under 1500grams and a hearing test which may be offered in
some centres to premature babies.
Are there longer
term complications after RDS?
Longer term problems may develop if the RDS
has been severe. These include the development of bronchopulmonary
dysplasia (BPD) which means the baby will need
oxygen support for several weeks to a few months. Those who
have had BPD can develop temporary breathing problems when
they catch common respiratory infections such as colds and
may need to be readmitted to hospital for short periods of
time if these are bad. All babies born prematurely have an
increased risk of developing wheezing when they have a cold
and some will develop asthma. Most of these problems can however
be treated at home by the family doctor or paediatrician.
A few babies born prematurely can have problems with their
general development. This may happen following RDS but also
occurring in babies who did not have severe lung disease.
All babies born early undergo regular development checks in
the first 2 years of life to try to detect any problems.
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