Respiratory distress syndrome (RDS) is characterized by a progressive and frequently fatal respiratory disorder resulting from atelectasis and immaturity of the lungs.
a. Incidence.
Respiratory distress syndrome occurs almost exclusive in infants born before the 37th week of gestation. It occurs more often in infants of diabetic mothers, those delivered by cesarean section, and those delivered suddenly after antepartum hemorrhage.
This disease is the most common cause of neonatal mortality. In the US alone, it causes death of 40,000 newborns every year.
b. Cause.
Although the airways and alveoli of an infant’s respiratory system are present by the 27th week of gestation, the intercostal muscles are weak and the alveoli and capillary blood supply is immature. In RDS, the premature infant develops widespread alveolar collapse because of lack of surfactant.
c. Signs and Symptoms.
(1) May breathe normally at first.
(2) Rapid, shallow respirations, then prolonged apnea.
(3) Intercostal, subcostal, or sternal retractions.
(4) Nasal flaring.
(5) Audible expiratory grunting. A natural compensatory mechanism designed to produced positive end-expiratory pressure and prevent further alveolar collapse.
(6) Frothy sputum.
(7) Low body temperature.
NOTE: Early diagnosis is imperative so that treatment may begin immediately.
d. Treatment.
(1) Vigorous respiratory support.
(2) Warm, humidified, oxygen-enriched gases are administered by oxygen hood which is the treatment of choice.
(3) Mechanical ventilation.
(4) Radiant infant warmer or isolette.
(5) Sodium bicarbonate IV as necessary.
(6) Tube feedings or hyperalimentation.
e. Nursing Intervention.
(1) Monitor Arterial Blood Gases (ABGs).
(2) Monitor for infection, thrombosis, or decreased circulation to legs if the infant has an umbilical catheter.
(3) Take daily weights.
(4) Assess skin color.
(5) Monitor respiratory rate, depth, and character as well as other signs of distress.
(6) Provide parental teaching and emotional support; encourage bonding.