What is the most common cause and treatment for premature respiratory distress?

From the Guidelines

The most common cause of premature respiratory distress is Respiratory Distress Syndrome (RDS), which occurs due to surfactant deficiency in underdeveloped lungs of premature infants, and the treatment begins with preventive measures including antenatal corticosteroids and respiratory support with continuous positive airway pressure (CPAP) or mechanical ventilation, along with exogenous surfactant replacement therapy. The treatment approach for premature respiratory distress involves several key components.

• Preventive measures: Antenatal corticosteroids, such as betamethasone 12mg IM, two doses 24 hours apart, are given to mothers at risk of preterm delivery between 24-34 weeks gestation to accelerate fetal lung maturation 1.
• Respiratory support: This ranges from supplemental oxygen to CPAP starting at 5-6 cmH2O or mechanical ventilation if needed 1.
• Exogenous surfactant replacement therapy: This is crucial, typically using natural surfactant preparations like beractant (Survanta) 4mL/kg or poractant alfa (Curosurf) 2.5mL/kg instilled directly into the lungs via endotracheal tube 1.
• Supportive care: Maintaining normal temperature, careful fluid management, nutritional support, and monitoring for complications are essential 1. Early surfactant administration works by reducing surface tension in the alveoli, preventing collapse during exhalation and improving gas exchange, significantly reducing mortality from RDS in premature infants. Recent studies suggest that early use of CPAP with subsequent selective surfactant administration in extremely preterm infants results in lower rates of bronchopulmonary dysplasia/death compared to treatment with prophylactic or early surfactant therapy 1. Therefore, CPAP started at or soon after birth with subsequent selective surfactant administration may be considered as an alternative to routine intubation with prophylactic or early surfactant administration in preterm infants.

From the FDA Drug Label

12.1 Mechanism of Action

Endogenous pulmonary surfactant reduces surface tension at the air-liquid interface of the alveoli during ventilation and stabilizes the alveoli against collapse at resting transpulmonary pressures A deficiency of pulmonary surfactant in preterm infants results in Respiratory Distress Syndrome (RDS) characterized by poor lung expansion, inadequate gas exchange, and a gradual collapse of the lungs (atelectasis).

The most common cause of premature respiratory distress is a deficiency of pulmonary surfactant in preterm infants, which results in Respiratory Distress Syndrome (RDS). The treatment for premature respiratory distress is the administration of poractant alfa (CUROSURF), which compensates for the deficiency of surfactant and restores surface activity to the lungs of these infants 2. Key points about the treatment include:

• CUROSURF is administered directly to the lung
• It reduces mortality and pneumothoraces associated with RDS
• The recommended dose is 2.5 mL/kg (200 mg/kg) as a single dose or as multiple doses 2.

From the Research

Causes of Premature Respiratory Distress

• The most common cause of respiratory insufficiency in preterm infants, especially those born at <30 weeks of gestation, is Respiratory Distress Syndrome (RDS) due to surfactant deficiency 3, 4.

Treatment for Premature Respiratory Distress

• Surfactant therapy has been extensively studied in preterm infants and has been shown to significantly decrease air leaks and neonatal and infant mortality 3, 4.
• Continuous positive airway pressure (CPAP) has been used since the 1970s as a primary mode of treatment for RDS, and nasal continuous positive airway pressure (nCPAP) is an effective treatment of respiratory distress syndrome 5.
• Natural surfactants derived from animal sources containing surfactant proteins B (SP-B) and C (SP-C) have been shown to be more effective than synthetic surfactants in treating RDS, with poractant alpha resulting in a significantly decreased mortality, decreased need for additional doses, faster weaning of oxygen, and reduced hospital costs when compared to treatment with beractant or calfactant 3.
• Very early surfactant therapy without mandatory ventilation has been shown to decrease the need for subsequent mechanical ventilation, decrease the incidence of air-leak syndrome, and seems to be safe in premature infants treated with nasal continuous positive airway pressure early after birth 6.
• Prophylactic surfactant treatment at birth reduces the incidence of severe RDS in very premature babies, but is not recommended as it may increase the risk of lung injury or death 4, 7.