Hyaline membrane disease

Alternative names

Respiratory distress syndrome (RDS) in infants; Infant respiratory distress syndrome (IRDS); Neonatal respiratory distress syndrome; RDS - infants

Definition

Respiratory distress syndrome is one of the most common lung disorders in premature infants and causes increasing difficulty in breathing. See also ARDS (acute respiratory distress syndrome).

Causes, incidence, and risk factors

Respiratory distress syndrome affects 10% of all premature infants and only rarely affects those born at full-term. The disease is caused by a lack of lung surfactant, a chemical that normally appears in mature lungs. Surfactant keeps the air sacs from collapsing and allows them to inflate with air more easily.

In respiratory distress syndrome, the air sacs collapse and prevent the child from breathing properly. Symptoms usually appear shortly after birth and become progressively more severe.

Risk factors are prematurity, diabetes in the mother, and stress during delivery that produces acidosis in the newborn at birth.

Symptoms

• Rapid breathing
  
• Unusual breathing movement - drawing back of the chest muscles with breathing (see intercostal retractions)
  
• Shortness of breath and grunting sounds while breathing
  
• Nasal flaring
  
• Breathing stops briefly
  
• Bluish color of the skin and mucus membranes
  
• Arms or legs puffy or swollen
  

Signs and tests

• A blood gas analysis shows low oxygen and acidosis.
  
• A chest x-ray indicates respiratory distress (the lungs develop a characteristic "ground glass" appearance).
  
• Lung function studies may be necessary.
  
• Blood cultures and a sepsis work-up are usually done to rule out infection and sepsis as a cause of the respiratory distress.
  

Treatment

High-risk and premature infants require prompt attention by a pediatric resuscitation team.

First, the infant is given high oxygen and humidity concentrations. Infants with mild symptoms are given supplemental oxygen. Those with severe symptoms are managed on a ventilator to deliver both oxygen and pressure to keep the lungs inflated.