From the Guidelines
Respiratory Distress Syndrome (RDS) is a condition characterized by immaturity-related surfactant deficiency, leading to respiratory failure in preterm and term neonates. This condition is a major cause of morbidity and mortality in newborns, and its management is crucial to improve outcomes. The diagnosis of RDS is based on clinical presentation, including respiratory distress, and is confirmed by radiographic findings and laboratory tests 1.
Key Features of RDS
- Immaturity-related surfactant deficiency
- Respiratory failure in preterm and term neonates
- Clinical presentation includes respiratory distress, grunting, and retractions
- Radiographic findings include ground-glass appearance and air bronchograms
Management of RDS
The management of RDS involves surfactant replacement therapy, which has been shown to reduce mortality, decrease the incidence of pulmonary air leak, and lower the risk of chronic lung disease or death at 28 days of age 1.
Surfactant Replacement Therapy
- Surfactant administration in preterm infants with established RDS reduces mortality and improves outcomes
- Prophylactic or early administration of surfactant may result in fewer pneumothoraces and improved survival without bronchopulmonary dysplasia (BPD)
- Continuous positive airway pressure (CPAP) is also used routinely in the management of RDS, and its benefits are being studied in recent randomized clinical trials 1.
From the FDA Drug Label
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).
Respiratory Distress Syndrome (RDS) is characterized by:
- Poor lung expansion
- Inadequate gas exchange
- Gradual collapse of the lungs (atelectasis) It occurs due to a deficiency of pulmonary surfactant in preterm infants. 2
From the Research
Definition and Causes of Respiratory Distress Syndrome (RDS)
- Respiratory distress syndrome is the leading cause of mortality and morbidity among infants born prematurely 3
- The disorder arises from the developmental and biochemical abnormalities associated with preterm delivery 3
- The decreased number of type II alveolar pneumocytes results in absent or reduced surfactant production, which leads to alveolar instability and a tendency to collapse during expiration and increased work of breathing 3
Characteristics and Symptoms of RDS
- RDS is the most common cause of respiratory insufficiency in preterm infants, especially those born at <30 weeks of gestation 4
- RDS is characterized by respiratory distress, including signs such as tachypnea, grunting, and retractions 5
- The primary cause of RDS is pulmonary surfactant deficiency 6
Treatment and Management of RDS
- Surfactant replacement therapy has been shown to be effective in the treatment of neonatal respiratory distress syndrome and has become a standard of care in neonatal intensive care units 3
- Exogenous surfactant replacement therapy can decrease air leaks, neonatal and infant mortality, as well as cost among survivors 4
- Natural surfactants derived from animal sources and synthetic surfactants with functional SP-B- or SP-C-like protein mimics have been extensively evaluated in preterm neonates with or at risk for RDS 4
- The efficacy of surfactant therapy for neonatal RDS may be associated with gestational age, Apgar score, birth weight, starting time of surfactant therapy, and maternal steroid therapy 6