Neonatal respiratory distress syndrome

Disease Description (Causes and Symptoms)

• Definition summary: Neonatal respiratory distress syndrome (RDS) is a condition in which the lungs cannot expand properly immediately after birth and the alveoli collapse (atelectasis), leading to hypoxia and respiratory failure. It mainly occurs in premature infants due to a deficiency of pulmonary surfactant.
• Causes/pathophysiology: When pulmonary surfactant is deficient, it becomes difficult for the alveoli to restore their elasticity, resulting in decreased lung compliance, atelectasis, ventilation/perfusion (V/Q) mismatch, hypoxemia, and respiratory failure. Major risk factors include preterm birth (especially before 34 weeks), maternal diabetes, cesarean section (insufficient oxygen stimulus before delivery), male sex, and inadequate induction of lung maturity before cesarean section.
• Main symptoms: Rapid breathing (tachypnea) occurring immediately after birth or within several hours, chest retractions (intercostal retractions), expiratory grunting, flaring of the nostrils (snoring/nasal flaring), and cyanosis (decreased oxygen saturation). Mechanical ventilation is required as the condition progresses.

Treatment Methods (Standard Treatment·Precautions·Self-Management)

• Prevention (before delivery)
  • Antenatal corticosteroid administration is recommended for pregnant women at high risk of preterm birth to promote lung maturation.
• Initial management (immediately after birth)
  • Maintain warmth (insulation), secure the airway, manage fluids and blood glucose, and monitor (electrocardiography and oxygen saturation).
  • Noninvasive respiratory support: If the infant is stable, use CPAP (noninvasive positive-pressure ventilation) or high-flow nasal oxygen (HFNC).
• Medication/mechanical treatment
  • Exogenous pulmonary surfactant (artificial surfactant): Administered directly into the airway (according to guidelines for administration when symptoms occur or prophylactically). Effects are usually observed within several minutes to several hours; in severe cases, it may be repeated 2–3 times.
  • Mechanical ventilation (endotracheal intubation + ventilator): Used when CPAP is insufficient. A gentle ventilation strategy that minimizes injury is used (low pressure·low volume, permissive hypercapnia, etc.).
  • In some cases, antibiotics (when infection is suspected), fluid and nutritional supplementation, correction of blood gases, and other treatments may be given.
  • In very severe cases, advanced treatments such as ECMO may be considered (with strict indications).
• Precautions and complication management
  • Excessive oxygen increases the risk of retinopathy of prematurity (ROP) → Follow the target oxygen saturation range.
  • There are risks of air leaks (pneumothorax and pulmonary interstitial emphysema), endotracheal bleeding, and infection during mechanical ventilation and surfactant administration.
  • Possible long-term complications include bronchopulmonary dysplasia (BPD), intraventricular hemorrhage (IVH), sepsis, necrotizing enterocolitis, and patent ductus arteriosus (PDA); multidisciplinary follow-up is therefore necessary.
• Post-discharge management (self-management/home care)
  • For infants dependent on oxygen, follow oxygen-management instructions, prevent infection (handwashing and limiting visitors), and attend regular follow-up appointments (respiratory status, weight, and developmental assessments).
  • Vaccinations (particularly considering prevention such as palivizumab for high-risk groups before the RSV season), as well as nutritional and developmental support.

Checklist Before an Outpatient Visit (Including Items to Bring and Confirm, and Sample Questions)

• Items/documents to bring
  • Delivery records: gestational age, birth weight, APGAR score, type of delivery (vaginal delivery/cesarean section), and whether antenatal steroids were administered.
  • Current treatment summary: whether oxygen is being supplied and its concentration (FiO2), CPAP/ventilator settings, whether surfactant was administered and the number of doses, recent blood test and blood gas results, and chest X-ray findings (images if possible).
  • Medication list (medications and injections currently being administered), medication schedule, and other medical history (brain hemorrhage, infection, etc.).
  • Symptom records: respiratory rate, oxygen saturation trends, feeding (feeding volume and vomiting), weight changes, and changes in crying or level of alertness.
• Items to confirm before the outpatient visit (brief checklist)
  • Recent oxygen saturation (at rest and during inhalation), factors that worsen breathing difficulty (worsening during feeding or sleep), and signs of infection such as fever or discharge.
  • Treatments currently being used at home (portable oxygen, nutritional supplementation, etc.).
• Sample questions (questions that are helpful to prepare before asking the doctor during the visit)
  • "How have the oxygen saturation and respiratory rate changed recently?"
  • "How many times was surfactant administered, and is an additional dose needed?"

General Sample Questions to Ask the Doctor

• What are the main side effects of this treatment (for example, surfactant or a ventilator)?
• What is my child’s prognosis (short-term and long-term)? What developmental assessments and follow-up will be needed in the long term?
• What preparations are needed when taking my child home, and what symptoms require going to the hospital immediately in an emergency?

Examples of Disease-Specific Questions

• Regarding surfactant: "Has my child already received surfactant? If an additional dose is needed, what are the criteria (oxygen requirement, respiratory support settings, etc.)?"
• Regarding long-term prognosis: "Based on the current condition, how high is the risk of developing bronchopulmonary dysplasia (BPD), and what is the plan for respiratory and developmental follow-up?"