The World of Pregnancy

Infant Respiratory Distress Syndrome: Symptoms, Causes & Treatment!

Have you heard of IRDS, also known as infant respiratory distress syndrome? If you didn`t heard of it and you want to become a mother, then you need to inform yourself better about this as this is considered the most common medical condition of premature babies.

Infant Respiratory Distress Syndrome

What Is Respiratory Distress in Infants?

Infant respiratory distress syndrome, known as neonatal respiratory distress syndrome or lately more frequently respiratory distress syndrome of newborn or surfactant deficiency disorder, represents a medical condition that involves premature babies and which is caused by a structural immaturity and insufficient development of pulmonary production in the lungs. This syndrome can be a consequence of neonatal infection or a genetic issue with the production of surfactant associated proteins as well.

Most premature births involve a series of complications that require care on short or long term. It`s considered that a baby is born prematurely between week 32 and 37 of pregnancy, and those who come into this world before week 32 are known to be severely premature. IRDS generally affects around 1% of infants and represents the most important cause of death when it comes to preterm babies. The incidence decreases along with advancing gestational age, from around 50% in newborns born between weeks 26 and 28, to around 25% at weeks 30 – 31. IRDS, as it`s also known, is more common in the 2nd born in premature twins and newborns of diabetic mothers.

Because these babies leave the uterine cavity before are completely developed, they confront themselves with some of the following conditions:

  • Respiratory distress syndrome.
  • Infections.
  • Digestive system problems.
  • Neurological affections.
  • Issues in controlling body temperature.
  • Retinopathy (insufficient development of the retina).

Note: This syndrome is different from pulmonary hypoplasia, another essential cause of neonatal death which involves respiratory distress.

Infant respiratory distress syndrome is among the most common medical conditions which occur when premature babies are involved and especially in those born severely premature. A respiratory distress syndrome is the name of a breathing difficulty found under the age of 28 days for a baby born at term.

This medical condition prevents the baby from breathing normally and occurs basically in those who don`t have their lungs sufficiently developed.

Signs & Symptoms

In most situations, the signs occur a few minutes after birth. Still, they may pass unnoticed for a few hours. They include:

  • Blue/pale skin.
  • Shortness of breath.
  • Shortness of breath accompanied by sounds of mumble/moan during breathing.
  • Low urine discharge.
  • Mumble.
  • Rapid or superficial breathing.
  • Abnormal breathing movements (such as the withdrawal of chest muscles during breathing).

Prognosis of IRDS

The health state often worsens at 2 or even 4 days after birth. It`s needed to be considered the fact that premature babies don`t only suffer of this syndrome, but they struggle with many other affections, and their chances of survival are extremely low. That`s why, they often die in their first week of life. However, just as well their state of health may improve and live a normal life.

What Causes Respiratory Distress Syndrome in Infants?

The direct cause of this syndrome It`s insufficient development of the lungs. However, this issue might cause some genetic disorders as well.

Most causes of IRDS occur in babies born before the week 37. However, there`s a number of risk factors that include:  a brother/sister that presented IRDS, maternal diabetes, Caesarean birth, hypothermia, perinatal asphyxia, pre-term delivery induction, multiple pregnancies, male fetus, birth issues when the baby`s blood flow is reduced or rapid birth.

Secondary surfactant deficiency might occur due to intrapartum asphyxia, pulmonary infection, volumetric trauma to the lungs, oxygen toxicity along with pressure or diaphragmatic congenital hernia. Strangely, the risk of occurrence decreases significantly along with the usage of antenatal steroids, chronic or pregnancy-induced hypertension, maternal narcotic addiction and prolonged membrane rupture.

How Is Respiratory Distress Syndrome Diagnosed?

The diagnosis consists of the chest x-ray and clinical image that demonstrates the absence of the thymus (after around 6 hours), a small, uniform infiltrate (at times outlined as a “glound glass” appearance) which involves all the lung`s lobes, decreased lung volumes, and air- bronchograms. In serious situations, this will become exaggerated until the cardiac limits become inapparent. – Read this!

How Is IRDS Treated?

Treatment for IRDS generally starts immediately after the birth of the baby, occasionally in the same room where he was delivered.

Most newborns that show symptoms of this syndrome are rapidly moved to NICU (neonatal intensive care unit)

The most essential treatments of this syndrome are:

  • Surfactant replacement therapy.
  • Oxygen therapy.
  • Breathing support using a ventilator or NCPAP machine. These devices aids babies born prematurely breathe better.

Positive airway pressure can also be an option, preventing the use of the above-mentioned device in certain situations. Additionally, children require a calm environment, careful handling of nutrition or fluids, immediate treatment of infections. There`s also the possibility of using extracorporeal membrane oxygenation where the oxygen is sent using a device which imitates gas exchange in the child`s lungs (it`s not available for children who have a weight of less than 2 kg as their blood vessels are too small for granules.

The condition usually gets worse after 2 to 4 days from birth and then it gets easily improved. The most important period is between 2 and 7 days from birth. In certain situations, taking betamethasome from the mother before birth may prevent or even improve this condition. – Learn more!

Surfactant Replacement Therapy

Surfactant represents a liquid which covers the interior of the lungs. It aids keep the lungs open so that a newborn is able to breathe in air as soon as he/she is born.

Newborns with this medical condition receive surfactant until their lungs can begin making the substance by themselves. Surfactant generally is received using a breathing tube. This particular tube allows the liquid to go straight into the lungs of the baby.

As soon as the liquid is received, the breathing tube is then connects to a ventilator, or the newborn might get breathing support from the NCPAP machine. – Check this!

Surfactant is most often received right after birth in the same room where the baby was delivered in the attempt to prevent or treat this syndrome. It also might be received a few times in the following days, until the newborn can breathe better.

Oxygen Therapy

Newborns who have breathing issues might receive oxygen therapy. Oxygen is received through NCPAP machine or ventilator, or through a simple tube connected to the baby`s nose. The treatment will ensure that the newborns` main organs receive sufficient oxygen to work properly.

Breathing Support

Newborns that have IRDS often require breathing support until their own lungs begin making sufficient surfactant. Until the recent times, there was a mechanical ventilator that was generally used. This particular ventilator was in advance connected to a breathing tube which ran through the newborn`s nose or mouth.

In our days, there are more and more newborns that are receiving this type of support from the NCPAP machine. NCPAP pushes in a gentle manner air into the lungs of the infant through prongs placed in the nostrils of the newborn.

Complications

Complications may be caused by:

  • Too much oxygen administered.
  • Too much pressure applied on the lungs.
  • More severe illnesses (which may affect the brain or lungs).
  • Periods when the brain or other important organs don`t receive enough oxygen.

Specifically, complications consist in the accumulation of air or gas in:

  • The space that surrounds the lungs (pneumotorax).
  • The space from the chest between 2 pulmonary lobes.
  • The area between the heart and the thin sac which surrounds the heart.

There may also occur:

  • Bleeding or the brain or lungs.
  • Blood clots.
  • Issues with the lung growth or development.
  • Vision/hearing issues (sometimes even blindness).
  • Delayed mental development.
  • Intellectual disability associated with brain damage.
  • Vocal cord trauma because of intubation.
  • Infections from the hospital.
  • Necrotizing enterocolitis.
  • Apnea. – See also this!
  • Chronic lung disease.
  • Gastrointestinal perforation.

Prevention

First of all, premature birth should be avoided through regular visits to the doctor and by following his instructions. Also, when it`s possible, birth should be delayed until tests show the development of the fetal lungs. Corticosteroids (more specifically glucocorticoids which accelerate surfactant production) like dexamethasone might be quite helpful when it comes to pulmonary maturation and are generally administered between 24 and 34 weeks. If birth becomes imminent, it`s administered 24 hours to 7 days before birth because they aren`t very useful with every birth. Also, it`s essential to monitor the mother`s diabetes and avoid hypothermia when the baby is concerned.

It seems that half of the babies who are born before the week 28 of pregnancy suffer from this syndrome, but the prognosis becomes favorable because of the development of medical procedures, especially when it comes to babies with a weight over 1.500 g. Unfortunately, it still remains the most frequent cause of newborn death in the first few weeks of life, so therefore this is a very serious medical condition which requires monitoring with great care.

Image courtesy of slideshare.net
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