Neonatal respiratory distress syndrome
The syndrome of respiratory distress in babies (RDS) or hyaline membrane disease (MHS), is the most frequent respiratory pathology in premature babies, its prognosis is serious and puts the life of the newborn at risk.
Below you have an index with all the points that we will discuss in this article.
Index
Neonatal respiratory distress syndromeIt hinders the normal breathing of the newborn and its incidence increases inversely with respect to gestational age, so that it affects 60% of those under 28 weeks and less than 5% of those over 34 weeks.
Respiratory distress syndromeCauses hyaline membrane disease
SDR occurs in newborn babies with lungs that have not yet fully developed. The disease appears in the absence of surfactant or surfactant, a slippery and protective substance produced by type II pneumocytes (lung cells) that lines the pulmonary alveoli and allows them to open and close. If the alveoli do not open easily, not enough air enters the lungs and oxygen does not enter the blood and is not distributed through the cells.
This substance appears in the lungs fully developed, from the 36th week of gestation, therefore the SDR is more frequent in preterm infants.
In addition, prematurity other factors increase the risk of developing this syndrome:
- A brother who has suffered.
- Diabetes in the mother.
- Cesarean birth.
- Complications in childbirth that reduce circulation to the baby.
- Multiple pregnancy.
- I start very fast.
In contrast, there are situations that accelerate the appearance of surfactant, such as maternal hypertension, delayed intrauterine growth, premature rupture of membranes, and certain medications such as corticosteroids and tocolytics, can accelerate lung maturation due to the stress of these situations or to the effect of the drug.
symptom
Signs appear minutes after birth, or a few hours later, they can range from:
- Cyanosis: Bluish color of the skin and mucous membranes.
- Respiratory apneas
- Decrease in urine.
- Snoring.
- Nasal flutter, rapid and shallow breathing.
- Difficulty breathing and emitting hoarse sounds while breathing.
- Unusual respiratory movement: retraction of the chest muscles when it would have to expand.
Treatment
The treatment starts from an adequate resuscitation in the delivery room and, although it has improved a lot in recent years, there is still a lot of controversy.
It is recommended that before a picture of this type the newborn goes to the intensive care unit, where his heart rate, respiratory rate, blood pressure, oxygen pressure, carbon dioxide pressure and temperature will be monitored.
SDR treatmentAdministering a natural surfactant (of bovine or porcine origin) or synthetic agent is probably the most important medication for a good prognosis; But the dose and when it should be administered varies according to the drug, the experience with the medicine in each center ... so it is still a matter of investigation.
Babies are also given hot, humid oxygen to avoid damaging the epithelium of the airways. It must be administered with care to avoid side effects due to an excess of oxygen.
Respiratory assistance with a ventilator or ventilator may be life saving but its use should be limited because it can damage the baby's lungs. An alternative treatment is continuous positive airway pressure, which supplies air at low pressure through the nose.
Other additional treatments are:
- Oxygenation directly in the blood when a ventilator can not be used.
- Inhaled nitric oxide to improve oxygen levels.
Both with the administration of surfactant and with the management of assisted breathing, there is no clear consensus, and it is probably correct to follow one protocol or another according to the experience and results of each medical center.
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