Respiratory distress syndrome

Respiratory distress syndrome (RDS) is a relatively common condition resulting from insufficient production of surfactant that occurs in preterm neonates. 

On imaging, the condition generally presents as bilateral and relatively symmetric diffuse ground glass lungs with low volumes and a bell-shaped thorax.

RDS is also known as hyaline membrane disease (not favoured as reflects non-specific histological findings), neonatal respiratory distress syndrome, lung disease of prematurity (both non-specific terms), or as some authors prefer surfactant deficiency disorder 2

The incidence is estimated at 6 per 1000 births 2

Respiratory distress presents in the first few hours of life in a premature baby. Symptoms include tachypnoea, expiratory grunting, nasal flaring. The infant may or may not be cyanosed. Substernal and intercostal retractions may be evident. 

Risk factors include maternal diabetes, greater prematurity, prenatal asphyxia and multiple gestations.

Associated abnormalities are those that can occur in prematurity: germinal matrix haemorrhage, necrotising enterocolitis, patent ductus arteriosus, delayed developmental milestones, hypothermia and hypoglycaemia.

Immature type II pneumocytes cannot produce surfactant. The lack of surfactant increases the surface tension in alveoli causing collapse. Patients have a decreased lecithin: sphingomyelin ratio. Damaged cells, necrotic cells, and mucus line the alveoli.

Plain radiograph
  • typically gives diffuse ground glass lungs with low volumes and a bell-shaped thorax
  • often tends to be bilateral and symmetrical
  • air bronchograms may be evident
  • hyperinflation (in a non-ventilated patient) excludes the diagnosis
  • radiographs may show hyperinflation if the patient is intubated

RDS can be safely excluded if the neonate has a normal chest radiograph at six hours after birth.

If treated with surfactant therapy there may be a symmetric improvement.

Exogenous surfactant administration. Supportive oxygen therapy.

Complications
Acute
Chronic

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Article Information

rID: 1467
Systems: Chest, Paediatrics
Section: Pathology
Synonyms or Alternate Spellings:
  • Surfactant deficiency disease
  • Respiratory distress syndrome (RDS)
  • HMD
  • Infantile respiratory distress syndrome
  • RDS
  • Hyaline membrane disease
  • Surfactant deficiency disorder

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