Incidence incr w prematurity, Caucasian race, male gender, maternal diabetes, c-section, hypothermia, 2nd twin, perinatal asphyxia, previous infant with RDS; 60% under 30 weeks gestation; 5% over 34 weeks

Sx:Onset 0-4 h postpartum

Si:Grunting respirations, tachypnea, intercostal retractions, atelectasis, ductus murmur, flaring

Worsens over 1st 24-28 h, then resolves over 5-7 d

Bronchopulmonary dysplasia chronic lung disease in many from O₂ rx with scarring, and barotrauma (Nejm 1990;323:1793), perhaps helped w inhaled steroids (Nejm 1999;340:1005, 1036); pneumothorax; diaphragmatic hernia; patent ductus arteriosus, esp with fluid overload (Nejm 1983;308:743), rx with indomethacin (Nejm 1984;310:565); retinopathy of prematurity, esp in low-birth-weight (<1 kg) premies exposed to high light levels in NICUs (Nejm 1985;313:401) or 100% O₂ levels w pO₂ levels >80 mm Hg for >12 h (Nejm 1992;326:1050)

r/o TTN (transient tachypnea of newborn), a benign and common condition; group B strep and other infections; congenital heart disease and other anomalies

Lab:

Chem:Blood gases show respiratory acidosis, hypoxia; suspect if FiO₂ requirement >40%

Xray:Chest shows air bronchograms, “ground glass” appearance

Rx:

Prevent w steroids between 28-32 weeks if threatened premature delivery, >24 h but <7 days prior to delivery, × 1 but not repeated (Nejm 2008;357:1179, 1190, 1248); but not helpful for low-birth-weight infants (Nejm 2001;344:95). Avoid steroids postpartum because diminishes school performance eventually (Nejm 2004;350:1304)

Prophylaxis:

• Surfactant prophylaxis endotracheally in infants 26 wk; at 1 yr use shows no benefit (Nejm 1991;325:1696) in morbidity, but survival is 30% better and drug costs less (Nejm 1994;330:1476). Therapeutically if >26 wk in multiple doses may help (Cochrane Database Syst Rev 2003;(4):CD000510)
• Ligation of ductus arteriosus prophylactically if <1 kg (Nejm 1989;320:1511)
• Inositol in TPN of premies × 5 d helps? (Nejm 1992;326:1233)
• Continuous nitric oxide; $3000/d (Nejm 2006;355:343, 354, 404)

Support by keeping warm (hypothermia causes bronchoconstriction); D₁₀W at 80-160 cc/kg/24 h to maintain glucose homeostasis, may need volume infusions to maintain BP or perfusion; continuous positive airway pressure (CPAP) or low-volume high frequency jet ventilation breathing via endotrach tube with surfactant (Nejm 1994;331:1051) or liquid perflubron (Nejm 1996;335:761); w nitric oxide? (Nejm 2006;355:343)