IRDS

Infant Respiratory Distress Syndrome 4/5/16

Causes of IRDS:

IRDS is caused by insufficient pulmonary surfactant production due to:

  • Premature birth
  • Genetic abnormalities



Individuals at risk:


  • IRDS's incidence is directly proportional to the degree of prematurity in a new born (the more premature a newborn, the greater risk of developing IRDS)
  • White or male babies
  • Previously birthing a baby who developed IRDS
  • Perinatal asphyxia
  • Cold stress
  • Multiple births
  • Perinatal infection
  • Newborns of diabetic mothers (the greater insulin in the newborn's system delays surfactant production)

Pathophysiology of IRDS:

  • A pulmonary deficient lung is characterized by collapsed airspaces alternating with hyperextended areas, vascular congestion, and overtime, hyaline membranes.
  • The membranes consist of damaged lung cells and fibrin that line and fill the alveolar-capillary bed, inhibit gas exchange.
  • As a result, the lungs have a difficult time expanding due to the thickened alveolar walls, and carbon dioxide rich blood is unable to adequately exchange with oxygen.
  • Blood oxygen levels fall, and carbon dioxide levels grow resulting in acidosis and hypoxia throughout the body.

Manifestations:

  • Difficulty breathing at birth that gets progressively worse
  • Cyanosis (blue coloring)
  • Flaring of the nostrils
  • Tachypnea (rapid breathing)
  • Grunting sounds with breathing
  • Chest retractions (pulling in at the ribs and sternum during

Complications:

  • Air leaks of the lung tissues such as:
  • Pneumomediastinum - air leaks into the mediastinum (the space between the two pleural sacs containing the lungs).
  • Pneumothorax - air leaks into the space between the chest wall and the outer tissues of the lungs
  • Pneumopericardium - air leaks into the sac surrounding the heart
  • Pulmonary interstitial emphysema (PIE) - air leaks and becomes trapped between the alveoli, the tiny air sacs of the lungs
  • Chronic Lung Disease

Treatment:

  • Placing an endotracheal tube into your baby's windpipe
  • Mechanical breathing machine (to do the work of breathing for the baby)
  • Supplemental oxygen (extra amounts of oxygen)
  • Continuous positive airway pressure (CPAP) - a mechanical breathing machine that pushes a continuous flow of air or oxygen to the airways to help keep tiny air passages in the lungs open
  • Surfactant replacement with artificial surfactant – this treatment has been shown to reduce the severity of HMD, and is most effective if started in the first six hours of birth. It may be given as preventive treatment for babies at very high risk for HMD, or used as a “rescue” method. The drug comes as a powder that is mixed with sterile water and given through the ET tube. This treatment is usually administered in several doses.
  • Medications (to help sedate and ease the baby's pain)