Neonatal respiratory distress syndrome (NRDS) more frequently affects the Caucasian boys, especially born to diabetic mothers by cesarean section, second born twins and children with a positive family history. On the other hand, maternal hypertension, antenatal steroid administration and prolonged membrane rupture seem to act as protective factors. Keeping this in mind, mothers should be counseled upon discharge in case they ever want to have another child.

The more prematurely the baby is born, the higher the chances of suffering from this ailment are. However, late prematurity is also associated with this disease [1]. The problem becomes apparent soon after birth, progressively worsens and its signs consist of tachypnea, increased respiratory effort with intercostal, suprasternal and substernal retractions, flaring of the nasal alae, expiratory grunting and cyanosis. In extreme situations, irregular breathing, apnea, and hypothermia are encountered. The consciousness state may be diminished and severe fatigability may be reported. In advanced cases, the patient requires ventilatory support and intensive care [2] [3].

Clinical examination reveals decreased breath sounds and peripheral pulses. Oliguria and peripheral edema can be encountered.

The surfactant deficiency may be secondary to several pathological processes, such as infectious or meconium aspiration pneumonia or pulmonary hemorrhage, intrapartum asphyxia, pulmonary hypoplasia or oxygen toxicity. Furthermore, the newborn may have other associated diseases, such as congenital diaphragmatic hernia, necrotizing enterocolitis or patent ductus arteriosus.

• Pneumonia

  However, surfactant therapy has been shown to be effective in the treatment of other diseases causing neonatal respiratory diseases such as pulmonary hemorrhage, meconium aspiration syndrome, pneumonia/sepsis, pulmonary edema or acute lung injury resulting [ncbi.nlm.nih.gov]

  Pulmonary infection - eg group B beta-haemolytic streptococcal pneumonia. Pulmonary haemorrhage. Meconium aspiration pneumonia. Oxygen toxicity along with pressure or volume trauma to the lungs. [patient.info]

  More African infants had congenital pneumonia, and interestingly, a greater proportion of African mothers had had premature rupture of the membranes. [fn.bmj.com]

• Tachypnea

  The symptoms usually appear shortly after birth and may include tachypnea, tachycardia, chest wall retractions (recession), expiratory grunting, nasal flaring and cyanosis during breathing efforts. [orpha.net]

  Symptoms manifest shortly after birth and include tachypnea, tachycardia, increased breathing effort, and/or cyanosis. The diagnosis is suspected based on clinical features and confirmed by evaluating the extent of atelectasis via chest x-ray. [amboss.com]

  Neonates with transient tachypnea are usually at term. [emedicine.com]

  Convert to ICD-10-CM : 770.6 converts directly to: 2015/16 ICD-10-CM P22.1 Transient tachypnea of newborn Approximate Synonyms Neonatal transient tachypnea Transient tachypnea (rapid breathing) of newborn Transient tachypnea of newborn Clinical Information [icd9data.com]

• Nasal Flaring

  The symptoms usually appear shortly after birth and may include tachypnea, tachycardia, chest wall retractions (recession), expiratory grunting, nasal flaring and cyanosis during breathing efforts. [orpha.net]

  There are 3 classic symptoms associated with respiratory distress syndrome: Intracostal retractions as the infant uses accessory muscles to support the work of ventilation Grunting as the epiglottis attempts to keep air in the lungs Nasal flaring as the [sharecare.com]

  2016 Topics: - Introduction - Cause & Risk Factors - Role of Maternal Diabetes in RDS - Role of Male Gender in RDS - Role of Prematurity in RDS - Role of Surfactant - Composition of Surfactant - Pathogenesis - Morphology - Clinical Features - Cause of Nasal [youtube.com]

  This infant will also probably have nasal flaring. What is most remarkable about the physical appearance of this baby? No. May increase P(a)O2, but any increase is merely transient. [quizlet.com]

• Rales

  Breath sounds may be normal or diminished and fine rales may be heard. Progressive worsening of cyanosis & dyspnea. Cyanosis and pallor increase & grunting decreases. Apnea and irregular respirations are ominous signs. [slideshare.net]

  Breath sounds can be clear or reveal rales on auscultation. [aafp.org]

• Periodic Breathing

  Methylxanthines increase minute ventilation, improve CO 2 sensitivity, decrease hypoxic depression, enhance diaphragmatic activity, and decrease periodic breathing [ 2 ]. [intechopen.com]

• Cyanosis

  A condition of the newborn marked by dyspnea with cyanosis, heralded by such prodromal signs as dilatation of the alae nasi, expiratory grunt, and retraction of the suprasternal notch or costal margins, most frequently occurring in premature infants, [icd9data.com]

  […] neonatal respiratory distress syndrome a condition of the newborn marked by dyspnea with cyanosis, preceded by symptoms such as dilatation of the nostrils, grunting on exhalation, and retraction of the suprasternal notch or costal margins. [web.archive.org]

  The symptoms usually appear shortly after birth and may include tachypnea, tachycardia, chest wall retractions (recession), expiratory grunting, nasal flaring and cyanosis during breathing efforts. [orpha.net]

  Tachypnea ( 60 breaths/min), nasal flaring, subcostal and intercostal retractions, cyanosis & expiratory grunting. Breath sounds may be normal or diminished and fine rales may be heard. Progressive worsening of cyanosis & dyspnea. [slideshare.net]

  Later signs of the infant's deteriorating condition include a change in the respiratory rate and apnea and the presence of cyanosis, especially around the oral area. [sharecare.com]

• Tachycardia

  The symptoms usually appear shortly after birth and may include tachypnea, tachycardia, chest wall retractions (recession), expiratory grunting, nasal flaring and cyanosis during breathing efforts. [orpha.net]

  Symptoms manifest shortly after birth and include tachypnea, tachycardia, increased breathing effort, and/or cyanosis. The diagnosis is suspected based on clinical features and confirmed by evaluating the extent of atelectasis via chest x-ray. [amboss.com]

• Oliguria

  Oliguria and peripheral edema can be encountered. [symptoma.com]

  These manifestations progress to apnea, flaccidity, unresponsiveness, mottling, peripheral edema, oliguria, hypotension, and bradycardia. [medical-dictionary.thefreedictionary.com]

  seizures, oliguria) 36. Pathophysiology 37. Chest x-ray: Areas of hyperexpansion mixed with patchy densities and atelectasis 38. [slideshare.net]

• Cervical Cyst

  Magnetic resonance imaging confirmed a left cervical cyst displacing the trachea and esophagus laterally. Surgical excision was performed via a cervical approach on the 5th day, and pathological examination revealed a bronchogenic cyst. [ncbi.nlm.nih.gov]

• Cervical Incompetence

  incompetence, or following preterm prelabour ruptured membranes. [ncbi.nlm.nih.gov]

An amniocentesis is able to predict if NRDS will occur after birth, based on the lecithin-to-sphingomyelin ratio the presence of phosphatidylglycerol in the amniotic fluid. If these tests are not available, birth is in progress at the time the mother comes to the hospital or fetal distress is seen and childbirth is required, the diagnosis is made after the delivery is done.

Once respiratory distress is noticed, the physician should determine its severity and arterial blood gases offer a good measurement tool. Central (umbilical) or peripheral arterial blood should be analyzed [4] and may show hypoxemia, hypercapnia and respiratory (caused by alveolar atelectasis) and metabolic (due to lactic acid accumulation) acidosis. If a congenital right to left shunt heart malformation coexists, hypoxia will be severe and the child is likely to be cyanotic. A patent ductus arteriosus can have the same results. Blood workup should include a blood glucose level, that is often low, a complete cell count, bilirubin level, renal and liver function and electrolytes.

Oxygenation may also be monitored using a less invasive method, pulse oximetry. Probes should be placed on the right wrist or palm in order to establish the preductal saturation and on either foot for postductal saturation. Saturation should be kept at 91-95% [5]. This is a good screening technique for congenital heart disease, but the diagnosis should finally be evaluated by echocardiography in selected cases.

A thoracic radiography is done in order to observe the pulmonary aspect. Pleural effusion, atelectasis or air bronchograms, interstitial emphysema, pneumothorax, bronchogenic cyst or pulmonary sequestration may be described by this exam. Cardiomegaly is often found and further characterization by echocardiography is required. Doppler echocardiography is reliable in determining if pulmonary hypertension is present. Hyperinflation (in a non-ventilated patient) or a normal aspect at 6 hours of age exclude the NRDS.

Pulmonary ultrasonography may be a reliable method [6] [7] that visualizes the existing pleural effusions [8]. However, pneumothorax is harder to find by lung ultrasonography [9].

If infection signs are detected, tracheal aspirate, cerebrospinal fluid and blood cultures should be obtained.

In situations where the outcome is unfavorable, a histology evaluation will describe the presence of hyaline membranes - an amorphous material, lining the alveolar spaces, collapsed alveoli alternating with hyper aerated ones and vascular congestion.

• Bilateral Atelectasis

  atelectasis (grade IV); (5) Arterial blood gas analysis showing hypoxia, hypercapnia and oxygen tension/fraction of inspired oxygen ratio (PaO 2 /FiO 2 ) 26.7 kPa. [omicsonline.org]

  atelectasis (grade IV); (4) arterial blood gas analysis showing hypoxia, hypercapnia, and oxygen tension/fraction of inspired oxygen ratio (PaO2/FiO2) 26.7 kPa. [hindawi.com]

• Hypercapnia

  Surfactant deficiency little or no reduction of alveolar surface tension reduced pulmonary unfolding atelectasis decreased lung compliance and functional residual capacity hypoxemia and hypercapnia References: [1] [3] Clinical features History of premature [amboss.com]

  • Laboratory findings are initially characterized by hypoxemia and later by progressive hypoxemia, hypercapnia, and variable metabolic acidosis. 14. [slideshare.net]

  Anoxia and hypercapnia cause acidosis, leading to peripheral vasodilatation and pulmonary vasoconstriction. This situation, in turn, leads to the reestablishment of a partial fetal circulatory pattern. [histopathology-india.net]

  Central (umbilical) or peripheral arterial blood should be analyzed and may show hypoxemia, hypercapnia and respiratory (caused by alveolar atelectasis) and metabolic (due to lactic acid accumulation) acidosis. [symptoma.com]

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2. Escobar GJ, Clark RH, Greene JD. Short-term outcomes of infants born at 35 and 36 weeks’ gestation: we need to ask more questions. Semin Perinatol. 2006;30:28-33.
3. Jain L, Eaton DC. Physiology of fetal lung fluid clearance and the effect of labor. Semin Perinatol. 2006;30:34-43
4. Billman GF, Hughes AB, Dudell GG, et al. Clinical performance of an in-line, ex vivo point-of-care monitor: a multicenter study. Clin Chem. 2002;48(11):2030-43.
5. Tarnow-Mordi W, Stenson B, Kirby A, et al. Outcomes of Two Trials of Oxygen-Saturation Targets in Preterm Infants. N Engl J Med. 2016; 374(8):749-60.
6. Liu J, Cao HY, Liu Y. Lung ultrasonography for the diagnosis of neonatal respiratory distress syndrome: a pilot study. Zhonghua Er Ke Za Zhi. 2013; 51(3):205-10.
7. Vergine M, Copetti R, Brusa G, et al. Lung ultrasound accuracy in respiratory distress syndrome and transient tachypnea of the newborn. Neonatology. 2014;106(2):87-93.
8. Ahuja CK, Saxena AK, Sodhi KS, et al. Role of transabdominal ultrasound of lung bases and follow-up in premature neonates with respiratory distress soon after birth. Indian J Radiol Imaging. 2012;22(4):279-83.
9. Sawires HK, Abdel Ghany EA, Hussein NF, et al. Use of lung ultrasound in detection of complications of respiratory distress syndrome. Ultrasound Med Biol. 2015;41 (9):2319-25.