respiratory distress syndrome of the newborn

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pertaining to respiration.
acute respiratory distress syndrome (adult respiratory distress syndrome) a group of symptoms accompanying fulminant pulmonary edema and resulting in acute respiratory failure; see also acute respiratory distress syndrome.
respiratory care
1. the health care profession providing, under qualified supervision, diagnostic evaluation, therapy, monitoring, and rehabilitation of patients with cardiopulmonary disorders; it also employs educational activities to support patients and their families and to promote cardiovascular health among the general public.
2. the care provided by members of this profession.
3. the diagnostic and therapeutic use of medical gases and their administering apparatus, environmental control systems, humidification, aerosols, medications, ventilatory support, bronchopulmonary drainage, pulmonary rehabilitation, cardiopulmonary resuscitation, and airway management.
respiratory distress syndrome, neonatal (respiratory distress syndrome of the newborn (RDS)) a condition of the newborn marked by dyspnea with cyanosis, heralded by such prodromal signs as dilatation of the nares, grunting on exhalation, and retraction of the suprasternal notch or costal margins. It usually occurs in newborns who are preterm, have diabetic mothers, or were delivered by cesarean section; sometimes there is no apparent predisposing cause.

This is the major cause of death in neonates and survivors have a high risk for chronic neurologic complications. No one factor is known to cause the condition; however, prematurity and interrupted development of the surfactant system is thought to be the major causative factor. Surfactant is secreted by the epithelial cells of the alveoli. It acts as a detergent, decreasing the surface tension of fluids that line the alveoli and bronchioles and allowing for uniform expansion of the lung and maintenance of lung expansion. When there is an inadequate amount of surfactant, a great deal of effort is required to re-expand the alveoli with air; thus the newborn must struggle for each breath. Insufficient expansion of the alveoli results in partial or complete collapse of the lung (atelectasis). This in turn produces hypoxemia and elevated serum carbon dioxide levels.

The hypoxemia causes metabolic acidosis from increased production of lactic acid and respiratory acidosis due to the hypercapnia. The lowered pH constricts pulmonary blood vessels and inhibits intake of oxygen, thus producing more hypoxemia and interfering with the transport of substances necessary for the production of the sorely needed surfactant.
Patient Care. In order to minimize the hazards of oxygen toxicity and retinopathy of prematurity, the blood gases of the newborn with respiratory distress syndrome must be carefully monitored to assess response to therapy. The goal is to administer only as much oxygen as is necessary to maintain an optimal level of oxygenation.

To improve respiratory function, intubation, suctioning of the air passages, and continuous positive airway pressure via nasal prongs are commonly used, as well as instillation of artificial surfactant. Monitoring is conducted using transcutaneous oxygen monitoring or a pulse oximeter. To optimize breathing effort and facilitate air exchange, the newborn is positioned on the back with a shoulder support to keep the neck slightly extended, or on the side with the head supported. Because of the drying effect of oxygen therapy and the prohibition of oral fluids, mouth care must be given frequently to prevent drying and cracking of the lips and oral mucosa.
respiratory failure a life-threatening condition in which respiratory function is inadequate to maintain the body's need for oxygen supply and carbon dioxide removal while at rest; it usually occurs when a patient with chronic airflow limitation develops an infection or otherwise suffers an additional strain on already seriously impaired respiratory functions. Inadequate or unsuccessful treatment of respiratory insufficiency from a variety of causes can lead to respiratory failure. Called also ventilatory failure.

Early symptoms include dyspnea, wheezing, and apprehension; cyanosis is rarely present. As the condition worsens the patient becomes drowsy and mentally confused and may slip into a coma. blood gas analysis is an important tool in diagnosing respiratory failure and assessing effectiveness of treatment. The condition is a medical emergency that can rapidly progress to irreversible cardiopulmonary failure and death. Treatment is concerned with improving ventilation and oxygenation of tissues, restoring and maintaining fluid balance and acid-base balance, and stabilizing cardiac function.
respiratory insufficiency a condition in which respiratory function is inadequate to meet the body's needs when increased physical activity places extra demands on it. Insufficiency occurs as a result of progressive degenerative changes in the alveolar structure and the capillary tissues in the pulmonary bed, as, for example, in chronic airflow limitation and pulmonary fibrosis. Treatment is essentially supportive and symptomatic. If the condition is not successfully managed it may progress to respiratory failure.
respiratory therapist a health care professional skilled in the treatment and management of patients with respiratory problems, who administers respiratory care. The minimum educational requirement is an associate degree, providing knowledge of anatomy, physiology, pharmacology, and medicine sufficient to serve as a supervisor and consultant. Those registered by the National Board for Respiratory Therapy are designated Registered Respiratory Therapist (RRT).
respiratory therapy respiratory care.
respiratory therapy technician a health care professional who has completed a specialized one- or two-year educational program and who performs routine care, management, and treatment of patients with respiratory problems under the supervision of a respiratory therapist. Such programs are usually found in community colleges and are accredited by the Joint Review Committee for Respiratory Therapy Education.

hy·a·line mem·brane dis·ease of the new·born

a disease seen especially in premature neonates with respiratory distress; characterized postmortem by atelectasis and alveolar ducts lined by an eosinophilic membrane; also associated with reduced amounts of lung surfactant.

respiratory distress syndrome of the newborn (RDS)

an acute lung disease of the newborn, characterized by airless alveoli, inelastic lungs, a respiration rate greater than 60 breaths per minute, nasal flaring, intercostal and subcostal retractions, grunting on expiration, and peripheral edema. The condition occurs most often in premature babies. It is caused by a deficiency of pulmonary surfactant, resulting in overdistended alveoli and at times hyaline membrane formation, alveolar hemorrhage, severe right-to-left shunting of blood, increased pulmonary resistance, decreased cardiac output, and severe hypoxemia. The disease is self-limited; the infant dies in 3 to 5 days or completely recovers with no aftereffects. Treatment includes measures to correct shock, acidosis, and hypoxemia and use of continuous positive airway pressure to prevent alveolar collapse. Also called hyaline membrane disease, idiopathic respiratory distress syndrome. Compare adult respiratory distress syndrome.
observations Signs and symptoms usually appear within 6 hours of birth and include rapid respirations, nostril flaring, expiratory grunting, chest retractions, labored breathing, frothing at lips, inspiratory crackles, cyanosis, and weak cry. These manifestations progress to apnea, flaccidity, unresponsiveness, mottling, peripheral edema, oliguria, hypotension, and bradycardia. Diagnosis is made by clinical exam, chest x-rays that display a diffuse granular pattern in bilateral lung fields indicating atelectasis, and bronchograms representing dilated air-filled bronchioles. Pulmonary function studies are run to differentiate a pulmonary from extrapulmonary illness. Blood gases are taken to determine the extent of respiratory function and acid-base imbalances. Possible complications include intraventricular hemorrhage, tension pneumothorax, retinopathy of prematurity, bronchopulmonary dysplasia, apnea, patent ductus arteriosus, congestive heart failure, neurological sequelae, necrotizing enterocolitis, pneumonia, sepsis, and/or death.
interventions Treatment is largely supportive. Exogenous surfactant is administered as soon as possible after birth and the infant is transported to the intensive care unit. Ventilation is started by continuous positive airway pressure. Warm, humidified oxygen therapy is used. Nutrition is managed by parenteral therapy (nipple and gavage feeding are contraindicated). Continued and aggressive laboratory monitoring of respiratory, circulatory, acid-base, and electrolyte status is performed. Blood transfusions may be necessary to replace blood lost during aggressive monitoring. Preventive measures are instituted with pregnant women by administering betamethasone injections to those mothers 24 to 48 hours before the delivery of any premature infant 24 to 34 weeks in gestation.
nursing considerations Acute nursing care is focused on adequate ventilation, oxygenation, maintenance of fluid and nutrition, and prevention of complications. Positioning aids in ventilation; use of blanket rolls and warmers reduces heat loss and lowers oxygen and glucose consumption and metabolic requirements. Careful intake and output, daily weights, and hydration assessments are used to monitor fluids and nutrition. Care clustering helps provide rest between the multiple interventions, such as suctioning, blood sticks, arterial blood gas draws, medication administration, and assessments. Parental support and education about infant treatments and monitoring are necessary. Parents should be educated about the self-limiting nature of the disease. The need for long-term medical follow-up should be stressed to monitor for and detect potential neurological and respiratory sequelae. Nursing also plays a role in the prevention of RDS by assisting pregnant women to maintain careful control of maternal diabetes and by encouraging early and consistent prenatal care.
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Respiratory distress syndrome in a newborn

res·pi·ra·to·ry dis·tress syn·drome of the new·born

(res'pir-ă-tōr-ē dis-tres' sin'drōm nū'bōrn)
An acute lung condition of newborn babies, characterized by tachypnea, nasal flaring, and respiratory grunting. The condition occurs primarily in premature babies due to a lack of surfactant, causing alveolar collapse.
Synonym(s): hyaline membrane disease.
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