Treatment of Respiratory Distress Syndrome in Neonates

Among neonates, the most common disorder is respiratory distress syndrome (RDS) also called “hyaline membrane diseases” (HMD). This acute lung disease often affects at the birth of a newborn, and it usually affects premature or preterm babies. In addition, infants that born prior to 28 weeks of pregnancy period may develop respiratory distress syndrome.

Treatment of Respiratory Distress Syndrome

A) Oxygen (0₂) Therapy

A relatively big baby born around 6 to 8 weeks premature may need no more than O₂ therapy to treat the condition. The natural history is that it becomes worse over the first 2 days, reaches a plateau than gradually improves.

B) Mechanical Ventilation

Smaller, more than premature and more severely affected babies commonly go into respiratory failure and require mechanical ventilation. Some babies require high concentration of O₂ (up to 100%) In such pharmacological concentration, the therapeutic index becomes an important issue.

Fortunately, pulmonary O₂ toxicity is not a problem to the neonate like adults. The chief concern is that, prolonged arterial hyperoxia can damage the retino-giving rise to retinopathy of prematurity.

C) Steroid Therapy

The incidence and severity of Respiratory distress syndrome caused by surfactant deficiency may be reduced by the antenatal administration of corticosteroid to the mother and this treatment reduces the mortality of infant by 40%.

The main advantage of maternal of steroid therapy is to save those babies of less than 32 weeks gestation because they are at greatest risk of death and disability from Respiratory distress syndrome.

It is ideal to give a 48 hour course of betamethasone or dexamethasone (six doses of 6 mg each, 8-hr interval) to repeat it after a week it delivery has not taken place but remain likely. Unfortunately, it is not possible to identify and treat all mothers whose babies could be benefited from this treatment.

D) Exogenous Surfactants

Recently various exogenous surfactants either artificial or derived from the pig or calf are introduced for the management of Respiratory distress syndrome.The natural surfactants are more effective than the artificial ones, but highly expensive.

Natural surfactants have rapid onset of action (within a minute), while artificial ones are effective over some hours.

E) Extracorporeal Membrane Oxygenation (ECMO)

Another method for the treatment of babies in respiratory failure is ECMO. ECMO effectively put a baby on heart lung by pass for a few days. This treatment can be helpful for some respiratory failure babies of at least 2kg birth weight, when conventional mechanical ventilation is unsuccessful.