​Kembara Xtra - Medicine - Neonatal Respiratory Distress Syndrome

​Kembara Xtra - Medicine - Neonatal Respiratory Distress Syndrome 
Neonatal respiratory distress syndrome (NRDS) is largely a prematurity-related illness characterized by respiratory distress.
Respiratory system(s) impacted Synonym(s): surfactant deficit; hyaline membrane illness
ALERT
a condition that affects newborns


Preterm births account for 10% of all newborns and >90% of all preterm births; incidence is inversely related to gestational age. Eighth greatest cause of newborn death in the United States in 2019: 11.3 infant deaths per 100,000 live births. Gender: slight male predominance

Pathophysiology and Etiology 
Low lung compliance, low lung volume, and high lung resistance are the results of impaired surfactant synthesis and secretion, which is typically a result of inadequate surfactant (dipalmitoyl lecithin) generation in developing lungs. Alveolar epithelium may sustain further damage as a result of high oxygen exposure and barotrauma during treatment.
Genetics
No genetic pattern is known

Risk factors include premature birth, babies born to diabetic moms, perinatal hypoxia, a sibling who has had RDS, and cesarean delivery. 

Prevention 
Premature birth prevention: - Prenatal treatment that is routinely provided - Management of maternal medical disorders
Promote healthy habits during pregnant by concentrating on:
- Diet
- Exercise - Refraining from using illegal drugs, alcohol, and tobacco 
Antenatal corticosteroids: for women between 24 and 33 weeks' gestation who are at risk for premature delivery within seven days, including those who have ruptured membranes and multiple pregnancies.


Associated Conditions 
Pneumothorax, bronchopulmonary dysplasia (BPD), and patent ductus arteriosus

Early therapies can change the typical prognosis in preterm neonates with worsening respiratory distress that starts at or shortly after birth and progresses over the first few hours of life.

Tachypnea, grunting, nasal flaring, subcostal and intercostal retractions, cyanosis, diminished breath sounds, pallor, diminished pulses, peripheral edema, and decreased urine output are all signs of a clinical condition. 

Differential diagnosis: Cyanotic congenital heart disease; Interstitial lung disease; Persistent pulmonary hypertension; Bacterial pneumonia; Temporary tachypnea in newborns;

Laboratory Results 

Initial examinations (lab, imaging)
Arterial blood gases (ABGs): Look for signs of hypoxemia, hypercarbia, and acid-base imbalances (respiratory and metabolic acidosis).
Chest radiograph (CXR): - A diffuse reticulogranular pattern that resembles ground glass - Bronchograms for air
- Minimal lung volume


Tests & Special Considerations

Blood glucose, a complete blood count, a blood culture, and other diagnostic procedures
A murmur on an echocardiogram should be taken into account when determining whether patent ductus arteriosus (PDA) and lung disease caused by L–R shunting are present.
(Autopsy results) Lung pathology - Macroscopically, the lungs have a consistently reddish, airless appearance. - Under a microscope, hyaline membranes (an eosinophilic and fibrinous membrane protecting air gaps) and diffuse atelectasis are visible.

Management 
Support for breathing
- If there is no respiratory failure, start using continuous positive airway pressure (CPAP) as soon as possible. - Intubate, ventilate as necessary, and give pulmonary surfactant if there is respiratory failure.
Options for respiratory monitoring - Unobtrusive
Target >90% to 95% O2 saturation with invasive pulse oximetry or an end-tidal CO2 monitor.
 Insertion of an umbilical artery catheter
Direct sampling of ABGs and empiric ampicillin and gentamicin antibiotic therapy while blood cultures are being evaluated Supportive services: Maintain a thermoneutral environment and sufficient perfusion.
- Maintain a proper electrolyte and fluid balance (prevent dehydration).
- Regular consumption of diuretics is not advised.
- Provide for dietary requirements

Pulmonary surfactants include Poractant alfa (Curosurf), a minced extract of pig lungs, Calfactant (Infasurf), a lavage extract of bovine lungs, and Beractant (Survanta), a minced extract of bovine lungs. Each of these medications has a unique delivery method; check local standards.
strong evidence for use with gestational ages 30 weeks; provide within first 30-60 minutes of life; balance with less intrusive kinds of respiratory assistance - Adverse consequences
-Bradycardia
-Hypotension
-Rapid changes in tidal volume (due to increased compliance) can result in a pneumothorax and a small risk of pulmonary hemorrhage, which are transient adverse effects that suggest surfactant administration should be temporarily halted until the neonate is stable and dosing can be resumed.
- Contraindications: child with laboratory evidence of lung maturity; congenital abnormalities incompatible with survival beyond neonatal period There is currently insufficient evidence to justify the use of diuretics on a regular basis. Caffeine improves respiratory drive. 

Retinopathy of prematurity (ROP) (ophthalmology), Necrotizing enterocolitis (NEC) (gastroenterology), and PDA (cardiology consult) are examples of comorbid disorders related with prematurity.

Further Treatments 

Premature problems should be treated.

Admission 
All newborns with respiratory distress need to be evaluated, watched after, and treated right away in the delivery room before being sent to a NICU.
Supportive care, a thermoregulatory environment, respiratory monitoring, and a relationship with the family to offer them information and emotional support are all necessary.
Prior to being discharged, a patient's vital signs and pulse oximetry should be stable, and a medical home and support services should be established.

Take Action 
Infants should be constantly monitored by their doctors after being discharged to check on their development and respiratory symptoms.
DIET As prescribed by a doctor


Modification of Lifestyle 

• Informing parents of potential dangers associated with subsequent pregnancies; • advising parents of potential problems with chronic lung illness.

Prognosis 
Prognosis and outcome are largely dependent on gestational age; substantial neurodevelopmental delays in almost half of newborns 25 weeks' gestation; survival unusual in infants 25 weeks' gestation. Prognosis Progressive worsening of clinical picture throughout first two days of life

Complications 
NRDS-specific problems include pneumothorax, chronic lung disease, BPD, and pulmonary interstitial edema (PIE). Additional complications may be caused by therapeutic procedures and coexisting diseases.

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