AKT · Child health/Neonatal & surgical

Respiratory distress syndrome (RDS)

Surfactant deficiency in the preterm lung (hyaline membrane disease)

Overview

Surfactant deficiency in the immature lung — the commonest respiratory problem of PRETERM infants. Without surfactant, alveoli collapse, causing respiratory distress from birth/within hours, with a 'ground-glass' CXR and air bronchograms. Antenatal corticosteroids (to the mother) and postnatal surfactant ± respiratory support are the mainstays; complications include pneumothorax and chronic lung disease (BPD).

Recognise

PRETERM infant with respiratory distress from birth/within hours: tachypnoea, grunting, nasal flaring, intercostal/subcostal recession, cyanosis
CXR: diffuse 'GROUND-GLASS' appearance with air bronchograms, reduced lung volumes
Risk: prematurity (less surfactant), maternal diabetes, male, C-section without labour

Red flags

Worsening distress → pneumothorax (sudden deterioration), need for escalating support
Progression to chronic lung disease of prematurity (BPD)

Differentials & how to tell them apart

Transient tachypnoea of the newbornTERM/late-preterm (often C-section), resolves in 1-2 days, fluid in the fissures on CXR

Congenital pneumonia/sepsis (GBS)can mimic RDS — treat with antibiotics if suspected

Meconium aspirationterm/post-term, meconium-stained liquor, patchy CXR

Investigations

Clinical + CXR (ground-glass, air bronchograms); blood gas (respiratory acidosis/hypoxia); exclude sepsis/pneumonia.

Management

Antenatal steroids (prevent) + surfactant + CPAP/ventilation

1Anticipated preterm delivery → ANTENATAL CORTICOSTEROIDS to the mother (lung maturity). Postnatally: respiratory support (CPAP/ventilation), oxygen, and exogenous surfactant for established RDS; treat as sepsis until excluded.Gate: Antenatal maternal corticosteroids are the single most effective prevention; cover for congenital pneumonia/GBS sepsis (which mimics RDS) with antibiotics until excluded; watch for pneumothorax
2Wean respiratory support; manage complications (pneumothorax, BPD); nutrition and developmental care.

Antenatal corticosteroids (to the mother) — the key PREVENTION — accelerate fetal lung maturity if preterm delivery anticipated

Exogenous surfactant (endotracheal) — treats established RDS

Respiratory support (CPAP/ventilation), oxygen — non-invasive CPAP first where possible

Key points

Preterm + respiratory distress from birth + ground-glass CXR = RDS (surfactant deficiency). Antenatal steroids prevent it; surfactant + CPAP treat it. TTN is the term/C-section mimic that resolves quickly.

Monitor & prognosis

Respiratory support, gases, complications (pneumothorax/BPD).

Good with treatment; BPD in the very preterm.

Source: RCPCH; BAPM; NICE