RESPIRATORY DISTRESS SYNDROME
This is a condition that occurs due to lack of or inadequate surfactant in the lung tissue. Mature lungs have adequate surfactant factor that lower the surface tension in the alveoli, stabilizes the alveoli and prevents them from adhering together and collapse. This leads to breathing with ease. Surfactant is produced slowly from 20 weeks gestation and reaches a surge at 30- 34 weeks gestation and another surge at onset of labour.
The premature infant lack this function thus the alveola walls pressure rises as he breaths out and alveoli collapse leading to severe difficulty in breathing.
Other names are:
· Hyaline membrane disease
· Pulmonary syndrome of the newborn
· Developmental respiratory distress
It is a disease of prematurity and self limiting with recovery phase or death.
PREDISPOSING FACTORS
v RDS may be a complication of asphyxia and develops within 48 hrs of birth
v Prematurity due to inadequate surfactant factor
v Perinatal hypoxia e.g due to APH which reduces surfactant synthesis
v Perinatal hypoxia
v Profound hypothermia –leads to injury of cells that produces surfactant
v Congenital heart disease
CLINICAL FEATURES
ü difficulty in breathing- dyspnoea
ü flaring of the alaenasi
ü tachypnoea with respiration of above 60/min
ü Hypothermia
ü generalized cyanosis
ü costal and sterna retraction
ü grunting expiration ( prevent atelectasis)
ü reduced or increased heart rate
ü chest X-ray shows collapsed alveoli
ü the baby has poor muscle tone and is motionless
ü poor digestion due to diminished bowel movement
ü resolves or death occurs within 3-5 days
NURSING MANAGEMENT
Management is symptomatic until the disease resolves.
If RDS is anticipated, inform the paediatrician to resuscitate the baby.
Nurse the baby in an incubator to prevent hypothermia by controlling the body temperature.
Administer oxygen or do artificial ventilation to prevent hypoxia.
Closely monitor the blood PH to prevent acidosis and support pulmonary circulation because high carbon dioxide level leads to constriction of pulmonary arterioles leading to poor pulmonary blood flow.
In case there is acidosis, sodium bicarbonate is added to 10 % dextrose drip.
Keep the baby nil per oral till the distress resolves.
Administer IV fluids eg.10% dextrose and add calcium gluconate to strengthen heart muscles; sodium bicarbonate to ensure fluid electrolyte balance.
Check heamocrit (PCV) and if less than 40% transfuse with blood.
Maintain the normal BP with volume expanders eg. n/saline.
Position the baby to provide greatest air entry(prone position with extended head)
Suction and do postural drainage to remove secretion and keep the airway patent.
Close observation to monitor the progress whether improving or deteriorating i.e. the heart rate, respiration, chest in- drawing, grunting respiration, and cyanosis.
When the condition resolves, introduce oral feeds. Incase the baby develops abdominal distention due to ingestion, stop the oral feeds and start IV fluids.
NB: principles followed during care of babies with respiratory problems are observation, oxygenation, positioning, nutrition and hydration.
PREVENTION
l Early detection and management of high risk pregnancies to prevent premature delivery
l Conditions such as diabetic mellitus should be properly managed so that delivery can be prolonged to 36 -38 weeks. The mother is given Dexamethasone 4mg tds 48 hrs before c/s to stimulate lung maturity.
l Prevent prenatal hypoxia by ensuring there is no intracranial injury at birth.
l Effective resuscitation at birth of high-risk babies.
l Assessment of gestational age and lungs maturity through amniocentesis so that elective c/s or delivery can be delayed if lungs are not mature enough
COMPLICATIONS
Ø Retrolentalfibriplasia
Ø Hypothermia
Ø Hypoglycaemia
Ø Patent ductusarteriuosus
Ø Abdominal distension
Ø Hypocalcaemia
Ø Intracranial
Ø Infection
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