Respiratory Distress Syndrome, Neonatal

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

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 2021: 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
No known genetic pattern

Risk Factors

• Premature birth
• Low birth weight
• Infants of diabetic mothers
• Infants of hypertensive mothers
• Perinatal asphyxia
• History of RDS in a sibling
• Cesarean delivery or operative vaginal delivery
• Assisted reproductive technology
• 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