Respiratory Distress Syndrome

Neonatal respiratory distress syndrome results primarily from pulmonary surfactant deficiency in premature infants. Surfactant deficiency causes alveolar collapse, reduced compliance, ventilation perfusion mismatch and hypoxaemia.

Risk rises sharply with decreasing gestational age.

Usually begins shortly after birth:

• Tachypnoea
• Grunting
• Nasal flaring
• Intercostal and subcostal recession
• Cyanosis
• Increasing oxygen requirement

Diagnosis is clinical and radiological.

Chest radiograph typically shows:

• Diffuse fine reticulogranular or ground glass appearance
• Air bronchograms
• Reduced lung volumes

Blood gas may demonstrate hypoxaemia, hypercapnia and respiratory acidosis.

• Start CPAP early in a spontaneously breathing preterm infant with respiratory distress.

• A starting CPAP pressure around 5 to 6 cm H₂O is commonly used and titrated according to respiratory effort and oxygenation. The neonatal protocol uses rescue CPAP beginning at a minimum of 5 cm H₂O.

• Titrate oxygen carefully, generally targeting SpO₂ approximately 91 to 95% in preterm neonates.

• Give exogenous surfactant when indicated, particularly when oxygen requirements rise despite adequate CPAP.

• Use mechanical ventilation when CPAP fails or recurrent severe apnoea, hypercapnia or exhaustion develops.