2. Respiratory distress Syndrome
Introduction
Manar Al-lawama , MD
Professor of Pediatrics & Neonatology

3. Yasmeen’s story
Mrs. Samia is a 21- year old lady. She gave birth to a 28 weeks gestational age premature newborn with a birth weight of 1200 gm

4. Gestational age
A clinical term usually given in weeks and days to describe human development timed from the first day of the last menstrual period (LMP). It is the age of pregnancy
Gestation period : weeks

5. Premature birth
Birth < completed 37 weeks GA
Extremely preterm (<28 weeks);
Very preterm (28–<32 weeks);
Late preterm (32–<37 completed weeks of gestation).

7. The human infant in the first 28 days
Newborn/Neonate
The human infant in the first 28 days
of life

8. NICU
Neonatal intensive care unit

9. Physiological changes at birth
Fetal Lung development
&
Physiological changes at birth

11. Pulmonary Surfactant A mixture of lipids (90%) and proteins (10%)
The four surfactant specific proteins (SP-A), SP-B, SP-C and SP-D
SP-B and SP-C : small hydrophobic proteins
SP-A and SP-D : large hydrophilic proteins

12. Surfactant
Secreted into the alveolar space by epithelial type II cells.
Main function: to lower the surface tension at the air/liquid interface within the alveoli of the lung.
Lower the work of breathing and to prevent alveolar collapse at end-expiration.

14. Transition
from
Fetal to Adult
Circulation

15. Respiratory transition at birth

16. Respiratory distress Syndrome

17. Yasmeen’s story
2 hours later, the neonatologist came to her room and she told her that Yasmeen has breathing difficulty

18. Respiratory Distress
Any deviation from the normal breathing pattern or efficacy , might reflect intrinsic respiratory problem or indirectly indicates disturbance in other systems

19. Respiratory distress syndrome (RDS)
Respiratory distress in the newborn infant that is caused by the lack of surfactant due to premature birth.

20. RDS Etiology : Lack of Surfactant Diagnosis
Clinical : combination of clinical and radiographic manifestations
Definite : Autopsy

21. Epidemiology Through out the world Slight male predominance
Risk factors : GA BW
Maternal diabetes
Asphyxia

22. Birth Weight & RDS 501-750 71% 751-1000 54% 1001-1250 36% 1251-1500
22%

23. Clinical Presentation
Respiratory distress
Increased O2 requirement
Onset shortly after birth
Classical radiographic finding

24. Signs Tachypnea: Respiratory rate > 60 bpm
Newborns minimize work of breathing by adjusting respiratory rate
Increase Minute ventilation

25. Signs 2-Retractions: Neonatal chest wall is extremely compliant
Stiff lungs
When retraction improves ,lung compliant is improving

26. Signs
3-Nasal Flaring :
Enlargement of nostril produced by contraction of the alae nasi muscles
Decrease nasal resistance

27. Signs
4-Grunting :
Sound produced by expiration through partially closed epiglottis
Equals to pressure of 2-3 cmH2O applied by continuous destinding pressure
Maintain FRC , improve V /Q

28. Signs
6-Cyanosis Bluish discoloration of the lips and mucus membranes At least 5mg/dl of deoxygenated Hb

29. CXR

30. Pathology

31. Pathophysiology Surfactant deficiency Hypoxemia Acidosis Barotrauma
High FiO2
Proinflammatory cytokines
Lung epithelial injury

33. Prevention & Treatment

34. Prevention 1
Prevent Prematurity

35. Prevention 2
Antenatal steroids
Prevention of asphyxia

36. Yasmeen’s story They had to intubate Yasmeen in order to
give her the treatment

37. Surfactant Gentle assisted ventilation Treatment
General supportive measures
Surfactant
Gentle assisted ventilation

38. Yasmeen Story
They took the tube out , and she is now breathing on a simple respiratory support device.
Mrs. Samia asked the doctor why did her baby had this rough course, The doctor said because she was born early!