What is the diagnosis and treatment for Acute Respiratory Distress Syndrome (ARDS) in infants?

From the Guidelines

Infants with Acute Respiratory Distress Syndrome (ARDS) should be treated with immediate respiratory support, including supplemental oxygen and mechanical ventilation, as well as surfactant replacement therapy, to reduce morbidity and mortality. The diagnosis of ARDS in infants is based on the presence of severe respiratory distress, diffuse unilateral or bilateral pulmonary infiltrates on chest X-ray (CXR) or computerized tomography (CT) of the chest, and the need for hospitalization in a pediatric intensive care unit (PICU) or neonatal intensive care unit (NICU) with intubation and mechanical ventilation 1. Key aspects of treatment include:

• Immediate respiratory support with supplemental oxygen, often delivered through continuous positive airway pressure (CPAP) at 5-8 cmH2O or mechanical ventilation if needed
• Surfactant replacement therapy with medications like beractant (Survanta) 4 mL/kg, poractant alfa (Curosurf) 2.5 mL/kg, or calfactant (Infasurf) 3 mL/kg administered directly into the lungs via endotracheal tube 1
• Supportive care, including maintaining proper fluid balance, nutrition, temperature regulation, and treating infections if present
• Prevention focuses on maternal corticosteroids (betamethasone 12 mg IM, two doses 24 hours apart) for women at risk of preterm delivery 1 It is essential to note that early recognition and treatment are critical to prevent complications like bronchopulmonary dysplasia, pneumothorax, or neurological damage from inadequate oxygen. Recent studies suggest that early use of continuous positive airway pressure with subsequent selective surfactant administration in extremely preterm infants may result in lower rates of bronchopulmonary dysplasia/death when compared with treatment with prophylactic or early surfactant therapy 1.

From the Research

Diagnosis of Acute Respiratory Distress Syndrome (ARDS) in Infants

• The diagnosis of ARDS in infants is based on clinical criteria, including respiratory distress, hypoxemia, and radiographic findings 2.
• The Murray lung injury score, which considers radiographic findings, ventilator settings, lung compliance, and blood gas results, can be used to diagnose ARDS in infants 2.

Treatment of ARDS in Infants

• Continuous positive airway pressure (CPAP) has been shown to be effective in reducing the need for mechanical ventilation and improving outcomes in preterm infants with respiratory distress syndrome (RDS) 3.
• Surfactant replacement therapy is a crucial part of management of RDS and can help improve lung function and reduce the need for mechanical ventilation 4, 5.
• Mechanical ventilation, including high-frequency oscillatory ventilation (HFOV), may be necessary in some cases, but should be used with caution to minimize lung injury 6.
• Other treatments, such as caffeine and postnatal steroids, may also be used to help manage RDS and reduce the risk of chronic lung disease 5.

Management of RDS in Preterm Infants

• A multidisciplinary approach to management is crucial, including optimization of prenatal care, delivery room management, and postnatal care 4, 5.
• Antenatal corticosteroids and timely transfer to a perinatal center can help reduce the risk of RDS and improve outcomes 5.
• Protocols for lung protection, including initiation of CPAP and titration of oxygen, should be implemented immediately after birth 5.
• Good temperature control, careful fluid and nutritional management, maintenance of perfusion, and judicious use of antibiotics are also important determinants of best outcome 5.