Respiratory Distress Syndrome (RDS) affects mostly premature infants. It is also known as Hyaline Membrane Disease. 

Their severity decreases as gestational age increases in newborns. 

Surfactant production start around 24th week and reaches adequate levels in 34th to 36th gestational week. 

Alveolar wash recovers surfactant with phospholipids, protein, and neutral lipids. Two small hydrophobic proteins, SP-B and SP-C are 2% to 4% of surfactant mass included in commercial surfactant preparations. 

Risk factors as follows: 

Prematurity 

Maternal diabetes 

Cesarean delivery 

Male gender 

Second-born twins 

24,000 newborns in the US per year experience respiratory distress syndrome due to prematurity. 

50% of neonates born at 26 to 28 weeks develop respiratory distress syndrome when compared to less than 30% newborn at 30 to 31 weeks. 

In developing countries, less respiratory distress syndrome occurs due to malnutrition and hypertension stress on premature infants before birth. 

Limited data on respiratory distress syndrome due to home births in developing countries. Respiratory distress syndrome reported globally in all races, most in White premature infants. 

Alveoli collapse due to insufficient surfactant leads to reduced lung compliance and increased breathing effort. 

Collapsed alveoli decreases gas exchange area, impair oxygenation, and increases carbon dioxide. 

Alveolar and capillary cell injury causes increased vascular permeability. Injury to the lung causes inflammation and release of cytokines to damage and impair gas exchange in a cycle. 

Low oxygen and high carbon dioxide levels cause serious health issues. 

Prematurity and low birth weight increase respiratory distress syndrome risk. 

Maternal diabetes, White race, male sex, late preterm, cesarean, laborless delivery increase complications risk.  

Surfactant deficiency leads to reduced lung function and increased dead space. 

Hyaline membranes in alveoli can form soon after birth. Epithelium starts healing in larger premature infants within 36-72 hours. 

Infants born very premature or to mothers with infection face chronic health issues. 

Infections can complicate respiratory distress syndrome management with failure to improve or WBC changes. 

Surfactant therapy helps small infants survive but may cause more septicemia cases from staphylococcal or candidal infection. 

Culture blood from two sites and start antibiotics or antifungal therapy promptly. 

Hypocarbia and chorioamnionitis are related with an increase in periventricular leukomalacia. 

Shunt complicates respiratory distress in infants weaned quickly after surfactant therapy. Suspect PDA if infant worsens or has bloody secretions. 

Maternal history includes detailed information of premature labor, maternal diabetes, and cesarean section. 

Neonatal history includes tachypnea, grunting, nasal flaring, and retractions. 

• Respiratory examination  
• Cardiovascular assessment 
• Auscultation 
• Abdomen evaluation  

• Progression of Symptoms with: 
• Increasing Respiratory Distress  
• Decreased Breath Sounds  
• Worsening Cyanosis 
• Deteriorating Blood Gases 

Use single dose antenatal corticosteroids to reduce respiratory distress syndrome risk. 

Surfactant therapy in tiny neonates with rapid extubation to nasal CPAP reduced need for ventilation and duration of mechanical ventilation, pulmonary air leakage, and 28-day mortality compared to selective surfactant therapy. 

Respiratory distressed neonates needing FIO2 above 0.40 should receive surfactant intratracheally within 2 hours of birth. 

Oxygen administered through a hood, nasal canula, or isolette was the main treatment before CPAP for infants with mild respiratory distress. 

Vapotherm used for neonatal respiratory support and early extubation with heated and humidified nasal cannula. 

High-frequency ventilation uses small tidal volumes at rapid frequencies to eliminate wide pressure swings. 

Inhalation of nitric oxide causes pulmonary vasodilation and may improve lung growth and reduce inflammation in infants. 

Infants with respiratory distress at birth should receive antibiotics post blood culture, CBC, and C-reactive protein tests. 

Cardiology, General

Critical Care/Intensive Care

Pediatrics, General

Use incubators or warmers for stable temperatures as premature infants are prone to hypothermia. 

Oxygen should be humidified and warmed to prevent airway drying and cooling. 

Minimize infant handling to reduce stress and maintain stable oxygen levels.
Place the baby in a comfortable position with head elevated to ease breathing and reduce abdominal pressure. 

For stable infants give breast milk through a nasogastric tube for proper nutrition. Breast milk is preferred for immunological and nutritional advantages. 

Proper awareness about RDS should be provided and its related causes with management strategies. 

Appointments with a pediatrician and preventing recurrence of disorder is an ongoing life-long effort. 

Cardiology, General

Critical Care/Intensive Care

Pediatrics, General

Beractant: 

It is a natural/modified bovine lung extract that reduces surface tension on alveolar surfaces during respiration. It is used only as an endotracheal route. 

Poractant: 

It stabilizes alveoli against collapse at resting transpulmonary pressures. It is used to treat respiratory distress syndrome in premature infants.  

Calfactant: 

It is a natural calf lung extract which contains phospholipids, surfactant-associated proteins B and fatty acids. 

Cardiology, General

Critical Care/Intensive Care

Pediatrics, General

Use continuous positive airway pressure (CPAP) for infants with mild to moderate RDS who are breathing spontaneously. 

Use mechanical ventilation for infants with severe RDS or those who fail CPAP. 

Cardiology, General

Critical Care/Intensive Care

Pediatrics, General

In prevention phase use off antenatal corticosteroids to accelerate fetal lung maturity and surfactant production. 

In acute intervention phase includes immediate post-birth management and respiratory support. 

In supportive care and management phase, patients should receive required attention such as lifestyle modification and intervention therapies. 

The regular follow-up visits with the pediatrician are scheduled to check the improvement of patients along with treatment response.