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Prevention and treatment of respiratory distress syndrome in preterm infants

Author
Richard Martin, MD
Section Editor
Joseph A Garcia-Prats, MD
Deputy Editor
Melanie S Kim, MD

INTRODUCTION

Respiratory distress syndrome (RDS), formerly known as hyaline membrane disease, is the major cause of respiratory distress in preterm infants.

The prevention, management, and complications of RDS in preterm infants will be reviewed here. The pathophysiology, clinical manifestations, and diagnosis of neonatal RDS are discussed separately. (See "Pathophysiology, clinical manifestations, and diagnosis of respiratory distress syndrome in the newborn".)

OVERVIEW

RDS is a result of surfactant deficiency, which causes increased surface tension in the air-liquid interface of the terminal respiratory units leading to atelectasis, increased ventilation-perfusion mismatch, and potential lung injury due to a marked pulmonary inflammatory response. RDS is the most common cause of respiratory distress in preterm infants because lung immaturity is associated with inadequate production of pulmonary surfactant. The incidence of RDS increases with decreasing gestational age, and infants born below 30 weeks gestation are at the greatest risk for RDS. (See "Pathophysiology, clinical manifestations, and diagnosis of respiratory distress syndrome in the newborn", section on 'Pathophysiology'.)

As RDS is generally due to lung immaturity, the best intervention would be to prevent preterm birth. However, if preterm birth cannot be avoided, RDS may be prevented or its severity decreased with the use of antenatal steroid therapy, early administration of positive airway pressure and, in some cases, exogenous surfactant therapy [1,2]. (See "Preterm birth: Risk factors and interventions for risk reduction".)

Despite the use of preventive interventions, RDS may still develop and be associated with both acute and chronic complications. Once the diagnosis of RDS has been established, management is a combination of the following:

                                        
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Literature review current through: Sep 2017. | This topic last updated: Sep 13, 2017.
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