Respiratory distress syndrome in newborns is one of the common symptoms or syndromes, especially in infants with low gestational ages. They are a group of diseases or pathological conditions, primarily reflects the deep lung immaturity with a primary or secondary surfactant deficiency, with the layering of various burdened factors, including infectious and iatrogenic.
In preterm infants, they constitute the basis for:
- SDR or HMD (hyaline membrane disease);
- in utero, intrapartum or postnatal pneumonia;
- hypoxic and hemorrhagic lesions of the brain;
- functioning arterial duct;
- interstitial and alveolar pulmonary edema;
- transient tachypnea of the newborn.
syndrome aspiration of meconium;
- in utero, intrapartum, and significantly less postnatal pneumonia;
- hypoxic brain damage;
- transient tachypnea of the newborn;
- cord trauma when damage to the spinal cord.
The term respiratory distress syndrome in newborns is currently associated not only with the disease of hyaline membranes, and that extends to other pathological condition or an illness with respiratory failure, a diagnosis that in the early days may not be updated.
In the differentiation of lungs x-rayed the lungs in the dynamics and assessed the clinical picture, taking into account the effectiveness of treatment. It is important to clarify whether the lung isolated disease if it is combined with other pathological conditions, or part of a generalized infection.
Clinical picture it is possible to allocate some variants of respiratory distress syndrome in newborns:
- children in need from the first hours of life in ICU and in intratracheal introduction Curosurf; these include children with gestation until 27-28 weeks (patients with HMD), with intrapartum infection Streptococcus of group b and some types of intrauterine pneumonia;
- children with a birth weight of 1200 g who have symptoms of respiratory failure may not appear immediately, but after a few hours after birth or on the 2nd day of life, as the destruction of surfactant, and which need not only in ICU but also in intratracheal introduction Curosurf;
- children requiring short-term intubation without the introduction of Curosurf;
- children for which treatment is sufficient to create light positive pressure using a nasal cannula (NCPAP);
- children receiving oxygen through a mask or funnel.
In the presence of full-term or premature baby with a large gestational age with birth or the first hours of life of the expressed syndrome of respiratory disorders of the newborn requiring ventilation with rigid parameters, primarily exclude in utero or intrapartum pneumonia. In addition to the radiological data in favor of pneumonia will testify to the serious condition of infectious toxicosis.
SDR, depending on the surfactant deficiency, observed mainly in children with the lowest gestational ages, up to 26-28 weeks, and the birth weight of 1250 g and significantly less in children with birth weight of 1251 to 1500 g.
Respiratory distress syndrome in newborns 86% of cases develop in infants with a birth weight of 501 to 750 g, in 75% of cases with a weight of 751 to 1000 g, in 48% of cases with birth weight of 1001 to 1250 g and 27% of cases with birth weight of 1251 to 1500 g.
The symptoms of respiratory failure is expressed already at birth or may appear during the first 6 h of life, although in some children they may develop later during the first and even the second day. The clinical picture is characterized by tachypnea, nasal flaring, retraction of the pliable portions of the chest and sternum, cyanosis, moaning "grunt" exhale; auscultation — weakened breath, and expiratory wheezing krepitiruyuschie.
The x-ray in severe cases, the disease is manifested by bronchograms, reduced pneumatization lung fields, granular-mesh pattern as a whole resembles frosted glass.
In moderate and severe forms of SDR is not complicated by underlying health conditions clinical manifestations of the disease on the background of artificial lung ventilation and intratracheal introduction Curosurf does not exceed 2-3 days.