Neonatal Respiratory Distress Syndrome: Diagnosis and Management

00:00 So, now for the clinical manifestations.

00:03 The signs and symptoms typically begin within minutes or hours after birth and progressively worsen over the first 48 to 72 hours of life.

00:13 Affected infants are often premature and show clear signs of respiratory distress.

00:19 These signs include tachypnea, nasal flaring, as the infant struggles to take in more air, respiratory grunting, a sound produced by breathing out against a partially closed glottis, and cyanosis.

00:33 Upon auscultation with a stethoscope, breath sounds may be normal or diminished, often with a harsh tubular quality.

00:40 You might also hear bilateral fine basal crackles.

00:43 Now an uncomplicated case typically progresses for 48 to 72 hours.

00:49 This is followed by an increase in the infant's own production of surfactant, leading to the resolution of respiratory distress by about one week of age.

00:58 An infant may also experience diuresis, which is an increase in urine production during this recovery process.

01:04 However, severe RDS or cases that are inadequately treated can lead to more serious developments, such as hypotension, cyanosis, a decrease or disappearance of grunting, mixed respiratory metabolic acidosis, and apnea with irregular respirations, which indicates the infant is becoming fatigued.

01:24 Several complications can arise from neonatal RDS.

01:27 These include respiratory failure, alveolar air leaks, such as interstitial emphysema or pneumothorax, pulmonary hemorrhage, and intraventricular hemorrhage.

01:37 Treatment with exogenous surfactant significantly improves the course of the disease and leads to a faster resolution of symptoms.

01:46 Now on to diagnosis.

01:48 The diagnosis begins at the bedside.

01:50 A preterm infant in respiratory distress immediately raises suspicion for neonatal RDS.

01:56 Clinical exam, as we just mentioned, typically reveals tachypnea, grunting, nasal flaring, and chest retractions.

02:05 We then confirm the picture with a chest x-ray, like the one you see on your screen right now.

02:11 This is showing the classic diffuse, fine, reticular granular, ground glass pattern with prominent air bronchograms that stand out against opacified lungs.

02:20 Note also the bell-shaped thorax, which is a clue to reduced lung volume.

02:26 Now arterial blood gases add biochemical evidence.

02:29 Here you'll see early hypoxemia that quickly improves with supplemental oxygen, followed by rising CO2 and a respiratory or mixed acidosis as the disease progresses.

02:40 Because RDS is fundamentally a disease of prematurity, the most effective preventive step is to delay delivery whenever possible.

02:49 However, when preterm birth threatens, amniotic fluid tests such as phosphatidylglycerol, the lecithin to sphingomyelin ratio, or a lamellar body count help gauge fetal lung maturity.

03:02 Finally, let's discuss the management of neonatal RDS.

03:06 Our approach in the delivery room is straightforward.

03:09 Support breathing gently.

03:10 Keep the baby warm and maintain basic stability until surfactant production takes over.

03:16 First, we use gentle positive pressure, usually nasal CPAP, to help open airways without forcing air in.

03:25 If that isn't enough to keep oxygen levels where they need to be, we'll move to brief intubation and give surfactant directly.

03:31 Once breathing is supported, we focus on keeping the infant in a neutral thermal environment, typically in a warmed isolette, so that energy isn't wasted on shivering or cold stress.

03:42 Next, fluids and nutrition aim simply to avoid dehydration or overload.

03:47 Small measured feeds, often via IV at first, until the baby can safely handle milk.

03:52 Finally, we watch blood pressure with gentle interventions, small fluid boluses or if needed low-dose pressors to ensure organs stay perfused.

04:02 And with that, we have covered the key concepts of neonatal respiratory distress syndrome.

04:07 Thanks for watching.