Pathophysiology, clinical manifestations, and diagnosis of respiratory distress syndrome in the newborn
- Richard Martin, MD
Richard Martin, MD
- Section Editor — Neonatology
- Professor, Pediatrics, Reproductive Biology, and Physiology & Biophysics
- Case Western Reserve University School of Medicine
Respiratory distress syndrome (RDS), formerly known as hyaline membrane disease, is a common problem in preterm infants. This disorder is caused primarily by deficiency of pulmonary surfactant in an immature lung. RDS is a major cause of morbidity and mortality in preterm infants.
The pathophysiology and clinical features of RDS will be presented here. The management of RDS and other disorders of perinatal transition are discussed separately. (See "Prevention and treatment of respiratory distress syndrome in preterm infants" and "Clinical features and diagnosis of meconium aspiration syndrome" and "Persistent pulmonary hypertension of the newborn" and "Transient tachypnea of the newborn".)
Knowledge of the normal fetal lung development is central to understanding the pathophysiology of neonatal RDS, which is due to inadequate surfactant activity resulting from lung immaturity.
Normal fetal alveolar development occurs in the following stages :
●Embryonic period – At approximately 26 days gestation, the embryonic stage begins with the first appearance of the fetal lung, which appears as a protrusion of the foregut. The initial branching of the lung occurs at 33 days gestation forming the prospective main bronchi, which begin to extend into the mesenchyme. Further branching forms the segmental bronchi as the lung enters the next stage of development.
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- LUNG DEVELOPMENT
- Pulmonary surfactant
- - Synthesis, secretion, and absorption
- - Prematurity
- Surfactant deficiency
- Inflammation and lung injury
- Pulmonary edema
- Surfactant inactivation
- Pulmonary function and gas exchange
- - Hypoxemia
- CLINICAL MANIFESTATIONS
- Clinical course
- Laboratory findings
- Differential diagnosis
- INFORMATION FOR PATIENTS
- SUMMARY AND RECOMMENDATIONS