RESPIRATORY Distress New New

RESPIRATORY
DISTRESS
SYNDROME
PRESENTED BY
• OKUNOLA VICTOR ADEYINKA NRS/2017/0048
• FASEUN OMOTOLA PRECIOUS NRS/2017/0032
• MIKAIL MARDIYYAH ABISOLA NRS/2017/0040
INTRODUCTION
• Infantile respiratory distress syndrome (IRDS), also
called respiratory distress syndrome of newborn, or
increasingly surfactant deficiency disorder (SDD)
(Northway Jr et al 1967) and previously called hyaline
membrane disease (HMD)
• It is a syndrome in premature infants caused by
developmental insufficiency of pulmonary surfactant
production and structural immaturity in the lungs.
• It can also be a consequence of neonatal infection
and can result from a genetic problem with the
production of surfactant-associated proteins.
(Santosham et al 2013).
INTRODUCTION
• RDS is caused by the baby not having enough surfactant
in the lungs. Surfactant is a liquid made in the lungs at
about 26 weeks of pregnancy. As the fetus grows, the
lungs make more surfactant.
• Surfactant coats the tiny air sacs in the lungs and helps
to keep them from collapsing. The air sacs must be
open to allow oxygen to enter the blood from the lungs
and carbon dioxide to be released from the blood into
the lungs.
• It affects about 1% of newborns and is the leading
cause of death in preterm infants. Other newborns can
also get RDS. (Rodriguez RJ, Martin RJ, Fanaroff AA
2002).
RISK FACTORS
Those at greater risk are:
Siblings with RDS infection

Twin or multiple births
C-section delivery
Mother with diabetes
Exposure to Infection
Baby is sick at the time of delivery
• Cold, stress or hypothermia. (Baby cannot keep body
temperature warm at birth)
CAUSES
• Meconium aspiration
• Pneumothorax
• Persistent pulmonary hypertension of the newborn
• Pulmonary hypoplasia
• Tracheoesophageal fistula
• Diaphragmatic hernia
• Infections
• Pneumonia
• Sepsis
• Meningitis
CAUSES (CONTD.)
Delayed transition
Congenital heart disease
Hypoglycemia
Polycythemia or anemia
Choanalatresia
Hydrocephalus
• Intracranial hemorrhage
PATHOPHYSIOLOGY OF RDS
• In premature infants, respiratory distress syndrome
develops because of impaired surfactant synthesis and
secretion leading to atelectasis, ventilation-perfusion
(V/Q) inequality, and hypoventilation with resultant
hypoxemia and hypercarbia.
• Blood gases show respiratory and metabolic acidosis
that cause pulmonary vasoconstriction, resulting in
impaired endothelial and epithelial integrity with
leakage of proteinaceous exudate and formation of
hyaline membranes (hence the name).
• The relative deficiency of surfactant decreases lung
compliance (see the image below) and functional
residual capacity, with increased dead space.
PATHOPHYSIOLOGY OF RDS (CONTD.)
• The resulting large V/Q mismatch and right-to-left

shunt may involve as much as 80% of the cardiac
output. Hypoxia, acidosis, hypothermia, and
hypotension may impair surfactant production and/or
secretion.
• In many neonates, oxygen toxicity with barotrauma
and volutrauma in their structurally immature lungs
causes an influx of inflammatory cell, which
exacerbates the vascular injury, leading to
bronchopulmonary dysplasia (BPD). Antioxidant
deficiency and free-radical injury worsen the injury.
EPIDEMIOLOGY
United States data
• In the United States, respiratory distress syndrome has
been estimated to occur in 20,000-30,000 newborn
infants each year and is a complication in about 1%
pregnancies.
• Approximately 50% of the neonates born at 26-28
weeks’ gestation develop respiratory distress
syndrome, whereas less than 30% of premature
neonates born at 30-31 weeks’ gestation develop the
condition.
Race-related demographics
• Respiratory distress syndrome has been reported in all
races worldwide, occurring most often in white
premature infants.
EPIDEMIOLOGY (CONTD.)
International data
• Respiratory distress syndrome is encountered less
frequently in developing countries than elsewhere,
primarily because most premature infants who are
small for their gestation are stressed in utero
because of malnutrition or pregnancy-induced
hypertension.
• In addition, because most deliveries in developing
countries occur at home, accurate records in these
regions are unavailable to determine the frequency
of respiratory distress syndrome.
SIGNS AND SYMPTOMS OF RDS
Most of the time, symptoms appear within minutes of
birth. However, they may not be seen for several hours.
Babies who have RDS may show these signs:
Bluish color of the skin and mucus membranes (cyanosis)
Brief stop in breathing (apnea)
Decreased urine output
Nasal flaring
High fever
• Elevated peak airway pressures
• Rapid breathing
• Shallow breathing
• Shortness of breath and grunting sounds while
breathing
SIGNS AND SYMPTOMS (CONTD.)
Unusual breathing movement (such as drawing back of the

chest muscles with breathing).
• Fast breathing very soon after birth
• Grunting “ugh” sound with each breath
• Changes in color of lips, fingers and toes
• Flaring (widening) of the nostrils with each breath
• Chest retractions. Skin over the breastbone and ribs
pulls in during breathing.
• Lung crackle sound on ascultation.
PROGNOSIS/COMPLICATIONS
Acute complications of respiratory distress syndrome
include the following
Alveolar rupture
Infection
Intracranial hemorrhage and periventricular
leukomalacia
Patent ductus arteriosus (PDA) with increasing left-to-
right shunt
Pulmonary hemorrhage
Necrotizing enterocolitis (NEC) and/or gastrointestinal
(GI) perforation
• Apnea of prematurity.
PROGNOSIS/COMPLICATIONS (CONTD.)
Chronic complications of respiratory distress syndrome

include the following:
Bronchopulmonary dysplasia (BPD)
Retinopathy of prematurity (ROP)
• Neurologic impairment
DIAGNOSIS
• Blood gases: Blood gases show respiratory and
metabolic acidosis along with hypoxia.
• Pulse oximetry
• Fetal lung maturity test: This is done by testing for the
presence of phosphatidylglycerol in the amniotic fluid
obtained with amniocentesis.
• Chest radiography and echocardiography: Chest
radiographs of a newborn infant with respiratory
distress syndrome reveal bilateral, diffuse, reticular
granular or ground-glass appearances; air
bronchograms; and poor lung expansion.
• Pulmonary mechanics testing: It helps in managing the
changing pulmonary course of premature newborn.
MEDICAL MANAGEMENT
• Corticosteroid
• Surfactant replacement therapy
• Delivery and resuscitation
• Oxygenation and CPAP
• Assisted ventilation
• Nitric Oxide
• Vapotherm
• Temperature regulation
• Circulation and anemia treatment
• Fluid, metabolic, and nutritional support
• Antibiotic administration
NURSING MANAGEMENT
Assess the general appearance to check for respiratory
distress, cyanosis, congenital disease e.g. cleft lip
• Physical examination: check the general appearance and
body measurements
• Identify and treat cause of the Acute respiratory distress
syndrome
• Administer oxygen as prescribed.
• Position client in high fowler’s position.
• Restrict fluid intake as prescribed.
• Provide respiratory treatment as prescribed.
• Administer diuretics, anticoagulants or corticosteroids as
prescribed.
• Prepare the client for intubation and mechanical
ventilation using PEEP.
NURSING MANAGEMENT (CONTD.)
• Monitor vital signs closely 30-60 mins for 4-6 hours
following birth and subsequently 8- 12 hours
• Monitor Respiratory status of the patient: respiratory
rate, breath sounds, and the use of accessory muscles;
arterial blood gas (ABG) levels; pulse oximeter and chest
x-ray results
• Monitor Response to treatment, mechanical ventilation,
immobility, and bedrest
• Monitor Presence of any complications (depends on the
precipitating condition leading to ARDS)
• Maintenance of body temperature
• Documentation
• Discharge and Home Healthcare Guidelines
NURSING DIAGNOSIS
• Ineffective Breathing pattern Ineffective breathing

pattern related to low amount of surfactant
evidenced by dyspnea
• Impaired gas exchange related to decreased area in
lungs for pulmonary circulation evidenced by
tachycardia
• Risk for decreased cardiac output related to positive
pressure ventilation.
• Ineffective Airway Clearance
• Anxiety
REFERENCES
Incidence of ARDS in the
USA: https://pubmed.ncbi.nlm.nih.gov/16236739/
Prone positioning in
ARDS: https://aacnjournals.org/aacnacconline/article/29/4
/415/2281/Acute-Respiratory-Distress-Syndrome-and-
Prone
• continuous bedside hemofiltration and prone positioning
on ARDS
patients: https://en.cnki.com.cn/Article_en/CJFDTotal-
HLSJ201803017.htm
• Arun K Pramanik, MD, MBBS. Respiratory Distress
Syndrome. Retrieved from;
https://emedicine.medscape.com/article/976034-
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RESPIRATORY

Those at greater risk are:

Siblings with RDS infection

• The resulting large V/Q mismatch and right-to-left

Unusual breathing movement (such as drawing back of the

Chronic complications of respiratory distress syndrome

• Ineffective Breathing pattern Ineffective breathing

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