Respiratory Distress Syndrome

DEFINITION -is one of the most common problems of premature babies.

-used to be called hyaline membrane disease
-It can cause babies to need extra oxygen and help to breathe.
- The course of illness with respiratory distress syndrome depends
on the size and gestational age of the baby, the severity of the
disease, the presence of infection, whether or not a baby has a
patent ductus arteriosus (a heart condition), and whether or not the
baby needs mechanical help to breathe.
-RDS typically worsens over the first 48 to 72 hours, then improves
with treatment.
-
ETIOLOGY - RDS occurs when there is not enough of a substance in the
lungs called surfactant. Surfactant is a liquid produced by the
lungs that keeps the airways (called alveoli) open, It begins
to be produced in the fetus at about 26 weeks of pregnancy.
- When there is not enough surfactant, the tiny alveoli
collapse with each breath. As the alveoli collapse, damaged
cells collect in the airways and further affect breathing
ability. The baby works harder and harder at breathing,
trying to reinflate the collapsed airways.
- As the baby's lung function decreases, less oxygen is taken in
and more carbon dioxide builds up in the blood. This can
lead to increased acid in the blood called acidosis, a
condition that can affect other body organs. Without
treatment, the baby becomes exhausted trying to breathe
and eventually gives up
- Risk factors

 Birth earlier than 25 weeks of gestation

 Birth at an advanced gestational age 
 Poorly controlled diabetes.
 Delivers at antepartum hemorrhage 
 Cesarean without antecedent labor 
 Presence of perinatal asphyxia
 Multiple births
 Previous infant with respiratory distress syndrome
 Rh factor incompatibility 

SIGNS AND
SYMPTOMS  Respiratory difficulty at birth that gets progressively worse
 Cyanosis (blue coloring)
 Flaring of the nostrils
  Tachypnea (rapid breathing)(60 to 120 bpm)
 Grunting sounds with breathing
 Low body temperature
 Chest retractions (pulling in at the ribs and sternum during
breathing)
 Bradycardia

PATHOPHYSIOLOGY

DIAGNOSTIC/LABS  Appearance, color, and breathing efforts (indicate a baby's

need for oxygen).
 Chest xray X-rays are electromagnetic energy used to
produce images of bones and internal organs onto film.
 Blood gases (tests for oxygen, carbon dioxide and acid in
arterial blood). These often show lowered amounts of
oxygen and increased carbon dioxide.
 Echocardiography. Sometimes used to rule out heart
problems that might cause symptoms similar to RDS.
Echocardiography is a type of ultrasound that looks
specifically at the structure and function of the heart.

MEDICAL
TREATMENT  Placing an endotracheal (ET) tube into the baby's windpipe
 Mechanical breathing machine (to do the work of breathing
for the baby)
  Supplemental oxygen (extra amounts of oxygen)
 Continuous positive airway pressure (CPAP). A mechanical
breathing machine that pushes a continuous flow of air or
oxygen to the airways to help keep tiny air passages in the
lungs open.
 Surfactant replacement with artificial surfactant. This is most
effective if started in the first six hours of birth.
 Medications (to help sedate and ease pain in babies during
treatment)
NURSING Assess respiratory status changes include:
ASSESSMENT - Tachypnoea (respiratory above 60 x per minute, maybe 80-
100)
- Breath grunting
- Nasal flaring
- Intercostal retraction, suprasternal or Substernal with the
use of auxiliary respiratory muscles
- Cyanosis
- Episodes of apnea, decreased breath sounds and presence
crakles.
NURSING
DIAGNOSES - Ineffective breathing pattern related to surfactant deficiency
and alveolar instability

- Impaired gas exchange related to immature pulmonary

function.

- Risk for injury (brain injury)related to hypoxemia.

NURSING
INTERVENTION    Assess pre-term infant for respiratory and general status

·         oxygen saturation ,cyanosis , ABG, axillary

temperature, respiratory pattern 

·         Maintain airway and administer oxygen @4-6 lit/min. 

·         Provide ventilatory support in case of need.Perform

gentle chest percussion, vibration and postural drainage
based on assessed need and infant tolerance. 

·         Monitor for signs of hyperthermia

(flushing,tachycardia, altered level of consciousness) and
hypothermia (decreased activity, respiratory distress
deterioration, cool mottled extremities)Place the infant in
radiant warmer , incubator. 

·         Use environmental control : warm cloths warm, well

ventilated room etc for decreasing heat loss.

·          Position the infant to facilitate open airway on the

side with head supported in aliment by a small folded sheet
(SMITING POSITION).

·         Quick gentle suctioning (not more than 5 sec)with fine

catheter as needed.

·         Maintain neutral thermal environment to decrease

metabolic requirement and to conserve oxygen utilization.

·         Maintain parenteral nutrition , avoid oral feeding or

through tube if child is in distress.

·          Maintain optimal nutrition pattern of infant

·         Once baby is breathing without distress NG feeding is

started.

·          Involves parent in the care of children and allow

frequent visit to encourage and promote infant – parent
bonding.

·          Skin care with frequent position change. Mouth care.