Respiratory Distress Syndrome, Neonatal

BASICS

DESCRIPTION

  • Neonatal respiratory distress syndrome (NRDS) is a disorder primarily of prematurity manifested by respiratory distress. However, it can occur in early term neonates as well.
  • System(s) affected: respiratory
  • Synonym(s): hyaline membrane disease; surfactant deficiency
ALERT

A disorder of the neonatal period

EPIDEMIOLOGY

Incidence

  • >90% incidence in infants born ≤28 weeks’ gestation
  • 1% all newborns, 10% of preterm infants
  • Inversely proportional to gestational age
  • Gender: male predominance
  • Eighth leading cause of infant death in the United States in 2022: 11.3 infant deaths per 100,000 live births (1)

ETIOLOGY AND PATHOPHYSIOLOGY

  • Impaired surfactant synthesis and secretion
    • Usually secondary to deficient surfactant (dipalmitoyl lecithin) production in immature lungs
    • Leads to low lung compliance, low lung volume, and increased lung resistance
  • High oxygen exposure and barotrauma during treatment can cause further damage to alveolar epithelium.

Genetics

NRDS is thought to be multifactorial with both genetic and environmental factors contributing to surfactant deficiency in both preterm and term infants but no current conclusive data is known.

RISK FACTORS

  • Premature birth
  • Low birth weight
  • Infants of diabetic mothers
  • Infants of hypertensive mothers
  • Perinatal asphyxia
  • History of RDS in a sibling
  • Male sex
  • White race
  • Cesarean delivery or operative vaginal delivery
  • Assisted reproductive technology/multiple gestation
  • Lack of prenatal care

GENERAL PREVENTION

  • Prevention of premature birth:
    • Education
    • Regular prenatal care
    • Management of maternal medical conditions
  • Promote healthy behaviors during pregnancy focusing on:
    • Diet
    • Exercise
    • Avoidance of exposure to tobacco smoke, alcohol, and illegal drugs
  • Antenatal corticosteroids:
    • For babies born between 24 weeks and 31 6/7 weeks gestational age, antenatal corticosteroid use when administered 2 to 7 days prior decreased the risk of NRDS, surfactant use, and death.
    • For women at risk for preterm delivery within 24 0/7 and 33 6/7 weeks’ gestation, including those with ruptured membranes and multiple gestations

COMMONLY ASSOCIATED CONDITIONS

  • Patent ductus arteriosus (PDA)
  • Bronchopulmonary dysplasia (BPD)
  • Pneumothorax
  • Recurrent wheezing, asthma, respiratory infections, and PFT abnormalities
  • Neurodevelopmental delay, cerebral palsy

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