Respiratory distress syndrome(RDS): Symptoms, Diagnosis, Pathogenesis & Treatments
Diagnosis
RDS is more prevalent with less maturity of the lung, so the shorter the gestational age and the smaller the birth weight, the higher the incidence. It is rarely seen in about 2% of all births, 60 ~ 80% at gestational age of less than 28 weeks, 15 ~ 30% at 32 ~ 36 weeks, 5% after 37 weeks and less than 1% at over 39 weeks. By weight, the incidence is 30-40% in very low birth weight infants less than 1500 g. There is no way to differentiate between hyaline membrane disease and surfactant after the administration of Surfactant, so it is difficult to make an accurate diagnosis, but it is likely that the HMD was mild or normal because the HMD was not seen in the initial chest x-ray photograph .
Pathogenesis
The pathophysiology of RDS can be summarized as follows. (1) Inhalation due to lack of surfactant; (2) Lack of air exchange in the alveoli, resulting in hypoxemia, hypercapnia, increased acidity, decreased resistance of lung compliance, decreased FRV, Physiological disturbance, and 4) the accumulation of multiple organs. In order to maintain normal pulmonary function, high pressure and high concentration of oxygen are required compared to normal children. Therefore, complications of lung air leaks such as pulmonary interstitial emphysema, pneumothorax, and mediastinum in the short term, And the incidence of the same chronic lung disease is high. In addition to the problem of the lung itself, pulmonary edema is promoted in early infants due to left and right shorts due to patent ductus arteriosus, resulting in pulmonary edema and hypoxia due to respiratory failure resulting in multiple organ failure.
Treatments
The treatment of RDS is to maintain the body temperature 36.5 ~ 37.5 ° C, to prevent heat loss, to treat hypothyroidism and hypotension, to maintain hemoglobin, to treat hemorrhoids, to prevent infection, to swallow infections, to correct hyperkalemia, And other high-risk newborns. The fluid starts with a 10% glucose solution at 65-75 ml / kg / day and gradually increases to 120-150 ml / kg / day. Surfactant replacement therapy is one of the most dramatic treatments that can improve RDS. In the short term, it can improve oxygenation, lower the MAP of the aneurysm, improve lung compliance, improve chest radiography, and reduce air leakages such as pneumothorax . There are preparations such as those extracted from the lungs of animals by animal species, those which are reconstituted on the basis of animal lung extracts, those composed of pure synthetic phospholipids, and in Korea, Surfacten , Newfactan and Curosurf extracted from the lungs of pigs, and Infasurf extracted from the lungs of cattle. Respiratory care should be done with appropriate ventilation therapy, aiming to maintain PaO2 50 ~ 70mmHg, PaCO2 45 ~ 65mmHg, pH 7.2 ~ 7.35. The reason for this is to prevent oxygen toxicity (ROP, BPD) by barotraumas (air-leak) and high-concentration oxygen which can be caused by high pressure while properly maintaining oxygenation in the infant.
RDS is more prevalent with less maturity of the lung, so the shorter the gestational age and the smaller the birth weight, the higher the incidence. It is rarely seen in about 2% of all births, 60 ~ 80% at gestational age of less than 28 weeks, 15 ~ 30% at 32 ~ 36 weeks, 5% after 37 weeks and less than 1% at over 39 weeks. By weight, the incidence is 30-40% in very low birth weight infants less than 1500 g. There is no way to differentiate between hyaline membrane disease and surfactant after the administration of Surfactant, so it is difficult to make an accurate diagnosis, but it is likely that the HMD was mild or normal because the HMD was not seen in the initial chest x-ray photograph .
Pathogenesis
The pathophysiology of RDS can be summarized as follows. (1) Inhalation due to lack of surfactant; (2) Lack of air exchange in the alveoli, resulting in hypoxemia, hypercapnia, increased acidity, decreased resistance of lung compliance, decreased FRV, Physiological disturbance, and 4) the accumulation of multiple organs. In order to maintain normal pulmonary function, high pressure and high concentration of oxygen are required compared to normal children. Therefore, complications of lung air leaks such as pulmonary interstitial emphysema, pneumothorax, and mediastinum in the short term, And the incidence of the same chronic lung disease is high. In addition to the problem of the lung itself, pulmonary edema is promoted in early infants due to left and right shorts due to patent ductus arteriosus, resulting in pulmonary edema and hypoxia due to respiratory failure resulting in multiple organ failure.
Treatments
The treatment of RDS is to maintain the body temperature 36.5 ~ 37.5 ° C, to prevent heat loss, to treat hypothyroidism and hypotension, to maintain hemoglobin, to treat hemorrhoids, to prevent infection, to swallow infections, to correct hyperkalemia, And other high-risk newborns. The fluid starts with a 10% glucose solution at 65-75 ml / kg / day and gradually increases to 120-150 ml / kg / day. Surfactant replacement therapy is one of the most dramatic treatments that can improve RDS. In the short term, it can improve oxygenation, lower the MAP of the aneurysm, improve lung compliance, improve chest radiography, and reduce air leakages such as pneumothorax . There are preparations such as those extracted from the lungs of animals by animal species, those which are reconstituted on the basis of animal lung extracts, those composed of pure synthetic phospholipids, and in Korea, Surfacten , Newfactan and Curosurf extracted from the lungs of pigs, and Infasurf extracted from the lungs of cattle. Respiratory care should be done with appropriate ventilation therapy, aiming to maintain PaO2 50 ~ 70mmHg, PaCO2 45 ~ 65mmHg, pH 7.2 ~ 7.35. The reason for this is to prevent oxygen toxicity (ROP, BPD) by barotraumas (air-leak) and high-concentration oxygen which can be caused by high pressure while properly maintaining oxygenation in the infant.
