What Is Respiratory Distress Syndrome?

Respiratory distress syndrome (RDS) almost always occurs in newborns born before 37 weeks of gestation, and the younger the gestational age, the greater the chance of developing respiratory distress syndrome. Newborns of diabetic mothers can occur, but in any palace of gestational age Delayed rupture of the membranes appears to have some effect in preventing respiratory distress syndrome in neonates with birth retarded or premature toxemia or neonates born to mothers with hypertension.

Respiratory distress syndrome

Acute Respiratory Distress Syndrome (ARDS) is a type of acute respiratory failure that causes vascular tissue fluid and fluid exchange disorders in the lungs due to various reasons (except left heart failure). Increased lung water content. Lung compliance. Reduced alveolar collapse. Ventilation blood flow. Proportional disorders are characterized by severe hypoxemia and extreme difficulty breathing.

Epidemiology and pathophysiology of respiratory distress syndrome

Respiratory distress syndrome (RDS) almost always occurs in newborns born before 37 weeks of gestation, and the younger the gestational age, the greater the chance of developing respiratory distress syndrome. Newborns of diabetic mothers can occur, but in any palace of gestational age Delayed rupture of the membranes appears to have some effect in preventing respiratory distress syndrome in neonates with birth retarded or premature toxemia or neonates born to mothers with hypertension.

A pulmonary surfactant is a substance that mixes phospholipids and three surfactant proteins

Respiratory distress syndrome

It is secreted by type alveolar epithelial cells. If there is a lack of pulmonary surfactant, the exudation of the water molecular layer at the alveolar air-liquid interface causes huge surface tension, which will cause alveolar collapse, reduce lung compliance, and stiff lung expansion. The work done increases, which will be more difficult for premature babies, because their ribs are easily deformed (compliance), and the force of breathing will cause deep sternal retraction, but little air will enter unless the ribs are well adapted to the lungs This has led to diffuse atelectasis.

Respiratory Distress Syndrome

Symptoms, signs and complications

Breathing is faster and more difficult. Breathing groaning often occurs immediately or within hours after birth, with inhalation in the upper sternum and inferior fossa, nasal flaps. The range of atelectasis and the severity of respiratory failure gradually increase, and in severe respiratory distress Syndrome, fatigue of the diaphragm and intercostal muscles cause CO2 retention and respiratory acidosis. Because blood cannot be exchanged when the blood passes through the atelectasis (such as right-to-left shunts in the lungs), hypoxemia occurs in the infant, leading to metabolism Acidosis.

Not all infants with respiratory distress have signs of respiratory distress.Very low birth weight infants (<1000g) cannot establish breathing at birth because their lung compliance is too poor and they cannot establish breathing in the delivery room.

There is a high risk of intraventricular hemorrhage and neonatal death in preterm infants with respiratory distress syndrome. Intracranial lesions (due to ischemia and intraventricular hemorrhage) and hypoxemia, hypercapnia, hypotension, arterial blood pressure fluctuations It is related to low cerebral blood flow perfusion (intracranial hemorrhagic shock and encephalopathy syndrome in childbirth). Tension pneumothorax is another complication of respiratory distress syndrome.

Clinical diagnosis of respiratory distress syndrome

diagnosis

It is not common to diagnose a newborn with 37 weeks of respiratory distress syndrome. At this time, it is suspected that the mother may have diabetes and was not found, or the diagnosis is incorrect. The diagnosis is based on medical history (such as premature birth, maternal diabetes and Estimates of fetal lung maturity), physical examinations (such as respiratory distress, cyanosis), and laboratory tests. Arterial blood gas shows varying degrees of hypoxemia and hypercapnia; chest X-ray shows the

Respiratory distress syndrome

Diffuse atelectasis (described according to the grade of bronchial inflators) is consistent with the clinical severity of respiratory distress syndrome (Table 260-1).

Respiratory distress syndrome must be distinguished from early Group B Streptococcus pneumonia and sepsis, which show similar radiological and clinical manifestations. Group B Streptococcus pneumonia is difficult to control, so antibiotics should usually be started before bacterial culture results are obtained use.

Respiratory Distress Syndrome Prevention

Determining the optimal birth time by assessing fetal lung maturity can greatly reduce the incidence of respiratory distress syndrome. Determination of pulmonary surfactant in amniotic fluid collected from amniocentesis or collected from the vagina (such as premature rupture of amniotic membrane has occurred), fetus Lung maturity is indicated by a lecithin / sphingomyelin ratio> 2 and the presence of glycerol phosphate.

For preterm infants who must give birth, dexamethasone is administered 24 hours before delivery to induce fetal lung surfactant production, which can reduce the risk or reduce the severity of respiratory distress syndrome