respiratory distress syndrome of newborn

respiratory distress syndrome of newborn

Hyaline membrane disease, respiratory distress Neonatology A morbid process seen in up to 50% of neonatal deaths–40,000/yr Clinical Atelectasis, hypoventilation, hypotensive shock, pulmonary vasoconstriction, alveolar hypoperfusion, shut-down of cell metabolism; 60% of HMD occurs in infants, most are < 28 wks of age; 5% occur in infants > than 37 wks; HMD is more frequent in the 2^nd twin delivered, twin-to-twin transfusion recipient infant, ♂ infants, children of diabetic mothers and in C-sections; a vicious cycle begins where ↓ surfactant results in atelectasis, ↓ ventilation–↑ pCO₂, ↓ pH, ↓ O2 and hypoxia exacerbating the lack of surfactant, causing shock and more hypoxia Clinical Early onset of tachypnea, prominent grunting, intercostal retractions–air hunger, cyanosis; the infants may not respond to O₂; blood pressure and corporal temperature fall, asphyxia intervenes and causes death, or the Sx peak at 3 days and the infant recovers DiffDx Neonatal pneumonia, birth-related asphyxia, group B streptococcal sepsis, cyanotic heart disease Treatment Supportive–O₂, correct acidosis, surfactant