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1. .
Submitted by
Mr. Om Prakash Choudhary
M.Sc. Nursing(pediatric )PGIMER CHD.

2. INTRODUCTION
 Infant respiratory distress syndrome (IRDS), also called
‘NRDS’ or hyaline membrane disease, is a syndrome caused in
premature infants by developmental insufficiency of
‘surfactant’ production and structural immaturity in the lungs.
 It can also result from a genetic problem with the production
of surfactant associated proteins.
 Respiratory distress is the highest risk in long term respiratory
& neurologic complications.

3. Respiratory Distress Syndrome
.It is also called HMD. It is condition of surfactant deficiency and physiologic
immaturity of thorax.
Presence of at least 2 of the 3 feature is essential.
 Tachypnea
 Retraction
 Expiratory grunt
It may be associated with multifetal pregnancies,
infants of diabetic mothers ,caesarian section,
pre-term delivery , asphyxia etc.

4. Phases of Lung Development

5. Surfactant
 Complex lipoprotein
 Composed of 6
phospholipids and 4
apoproteins
 70-80% phospholipids,
8-10% protein, and 10%
neutral lipids

6. Surfactant Metabolism

7. Normal Lung Hyaline Membranes

8. Causes:-
 Sepsis
 Exposure to cold
 Airway obstruction (atresia)
 Intra-ventricular hemorrhage
 Hypoglycemia
 Metabolic acidosis
 Acute blood loss
 Drugs

9. . Risk factors
deficient surfactant production
Unequal inflation of alveoli
Increased efforts to keep unstable alveoli open
Pulmonary vascular resistance increases
Hypo perfusion of lungs
Etiopathogenesis

10. Cont. Hypo perfusion of lungs
Right to left shunt
Hypoxemia , hypercapnia ,acidosis
Hyaline membrane formed
Inhibition of gas exchange
Decreased lung compliance
Respiratory distress syndrome

11. Clinical manifestations
 Tachypnea
 Tachycardia
 Chest wall Retractions
 Fine crackles
 Expiratory grunting
 Nasal flaring
 Central cyanosis
 Ventilator failure (rising CO2 in the blood)
 Extremities puffy or swollen
 apnea

12. Chest wall Retractions

13. Complications
 Metabolic disorders (acidosis, low blood sugar)
 Patent ductus arteriosus
 Low blood pressure
 chronic lung changes
 Intracranial hemorrhage

14. Diagnostic evaluation
 Laboratory findings include an arterial pco2 above 65mmof Hg
and a pH of 7.15 .
 The foam stability or shake test is done .
 Radiographic examination of chest shows areas of atelectasis .
 Prenatal Diagnosis
 History of premature delivery
 Concentration of lecithin in amniotic fluids.
 Ratio of lecithin/sphingomyelin
 Lecithin indicate lung maturity
 Sphingomyelin remains constant during
pregnancy
 L/S ratio 2:1 indicate lung maturity

15. low lung volume and the classic diffuse reticulogranular
ground-glass appearance

16. L/S ratio 2:1 indicate lung maturity

17. Cont.
 Assessment of severity of the respiratory Distress in
two methods
Paramet
er
0 1 2
RR(per
min)
<60 60-80 >80
Cynosis Absent In room
air
In
40%O2
Grunt Absent Audible
with a
Stethosc
ope
Audible
with a
nacked
ear
Retracti
on
Absent Mild Moderat
e –sever
Air
entry
Good Diminis
hed
Barely
Audible
Sign
s
0 1 2
Upper Chest Sync
hroni
zed
Lags
on
inspi
ratio
n
See
saw
respi
ratio
n
Lower Chest No
retra
ction
Just
visibl
e
Mark
ed
Xiphoid
Retraction
None Just
visibl
e
Mark
ed
Nares
dilatation
None Mini
mal
Mark
ed
Expiratory
Grunt
None Steth
osco
pe
only
Nake
d ear
A. Downe’score B. Silverman –Anderson score
•A score of >6 indicates impending respiratory failure and warrants mechanical
ventilation

18. B. Silverman –Anderson score

19. THERAPEUTIC MANAGEMENT
OXYGEN THERAPY
 Indications
1. Clinical central cyanosis
2. Hypoxemia (O2 saturation<87% and
PaO2<50mmHg in room air )
1. Neonates suspected RDS.
 Commonly used O2 delivery system in neonates:-
 Low flow system are commonly used in neonate. These
system provide a variable FiO2 depending upon the inspiratory
flow rate generate by the neonate.

20. Cont.
 Precaution while administering O2 :-
i. humidify
ii. O2 saturation should never cross 93% in preterm infant as –
hyperoxia leads
iii. Use O2 analyzer to check FiO2
 following way of oxygen therapy-
i. CPAP(continuous positive airway pressure)
ii. PEEP(positive end-expiratory pressure)
iii. SIMV(synchronized intermittent mandatory ventilation)
iv. HFV (high frequency ventilation)

21. Cont.
SURFACTANT THERAPY
 Indications:-
 Prophylactic:-preterm infants of <28wks gestation.
Administered within the initial 15-20min of life.
 Early rescue:-Administration is typical within the initial 2 hr
of life.
 Late rescue:- Administration is typical within the beyond24
hr of life.

22. Cont.
surfactant - commercially available
Medicine Dosage Max.dose Interval b/w
dose
Survanta
(Abbot)
100mg /kg
=4ml/kg
2 6h
Curosurf
(Nicholas/Abbot)
200mg/kg
(first)=2.5ml/kg
100mg/kg(repea
t)
=1.25ml/kg
2 12h
Neosurf
(Cipla)
135mg/kg
(5ml/kg)
2 12h

23. Cont.
 Medical therapy
• Maintenance of I/V line for hydration & nutrition
• Systemic antibiotics if sepsis
• Morphine, Lorazepam for pain & sedation
• Methylxanthines (Theophylline) for apnea
• VLBW & LBW needs mechanical ventilation
• Inotropes (dopamine & dobutamine) to support BP
• Blood transfusion / Erythropoitin therapy

24. .
Nitric oxide therapy
For relieving, persistent pulmonary hypertension, pulmonary
vasoconstriction, subsequent acidosis, severe hypoxia. NO
reduces pulmonary vasoconstriction & subsequent pulmonary
hypertension when inhaled into lungs (6-20ppm)
Prevention
 prevention of premature delivery especially in elective early
delivery (ELSCS)
 Improved amniocentesis methods for assessing the maturity of
fetal lung,
 administration of corticosteroid to induce surfactant production
(24 hours to 7 days before delivery).

25. Cont.
 Prophylactic surfactant therapy is not recommended
in infant greater than 30 weeks gestation
 Delaying premature birth. Tocolytics may delay
delivery by 48 hours and therefore enable time for
antenatal corticosteroids to be given.
 Good control of maternal diabetes
 Avoid hypothermia in the neonate

26. NURSING MANAGEMENT
 Nursing diagnosis
1 Impaired Gas Exchange related to decreased volumes and
lung compliance, pulmonary perfusion and alveolar ventilation.
2. Potential risk for hypothermia development related to
prematurity
3. Potential risk for infection due to prematurity, low immunity
& invasive procedure
4. Imbalance Nutrition Less Than Body Requirements related
to the inability to suck decreased intestinal motility.
NURSING CARE PLAN RDS.docx

27. Diagnosis
1.Impaired Gas Exchange related to decreased volumes
and lung compliance, pulmonary perfusion and alveolar
ventilation.
Intervention:-
 Monitor dyspnea, tachypnea, breath sounds, increased
respiratory effort, lung expansion, and weakness.
 Oxygen delivery in accordance with the additional requirements.
 Monitor vital signs. (T,P,R,B/P)

 See that the prongs are placed properly in the nostril of the baby
 See whether the prongs are of the size of the baby

 Do not ignore any alarm of the ventilator attached to the baby

28. 2. Potential risk for hypothermia
development related to prematurity
Intervention:-
 Care of the baby under radiant warmer
 Set the temperature of warmer accurately
 Fix the temperature probe to the baby’s abdomen
properly
 Check the baby’s temperature 2hrly with thermometer.
 Prepare injections under the laminar air flow (UV
light) using proper aseptic technique
 Clean the I/V site & change plaster when soiled

29. 3. Potential risk for infection due to prematurity,
low immunity & invasive procedure
 Intervention:-
 Wear sterile gown & chapels & wash hands before
entering NICU
 Wash hands thoroughly with soap & water & apply
sterlium before & after touching the Baby
 Ensure the baby is getting adequate feed
 Do place a thin plastic wrap on the cot of baby
 Maintain documentation

30. 4. Imbalance Nutrition Less Than Body
Requirements related to the inability to suck decreased
intestinal motility.
Implementation
 Facilitate rooming in.
 Allow mother to have good access to the baby
 Allow mother to touch & hold the baby
 Wash hands before preparing feeds
 Prepare feeds as suggested
 Teach the mother the manual expression of breast milk
 Give feeds with katori & spoon
 Weigh the baby daily
 Maintain intake output

31. NURSING CARE
 Nursing management with surfactant administration are-
1. Assistance in delivery of product.
2. Monitoring ABG and infants tolerance of procedure.
3. Monitoring oxygenation.
4. Delaying suctioning.
 Providing effective ventilation.
 Providing optimal enviromental temperature.

32. Cont.
 Adequate nutrition .
 Effective ventilation and oxygen therapy .
 Acid base balance.
 Normal hematocrit and blood pressure.
 Additional nursing management includes –
1. head elevation and hyperextension.
2. skin irritation from oxygen tubings.
3. Minimal handing.

33. summarization
 Introduction
 Definition
 Etiopathogenesis
 Clinical manifestation
 Diagnostic evaluation
 Assessment of severity of the respiratory Distress in two
methods
 Therapeutic management

34. References.
 Whaley & Wong’s, Nursing care of infant & children, fifth edition,
page 396-405
 Hockenberry, Wong’s Nursing Care of Infant & Children, eighth
edition, page;379-
 Dutta D C, textbook of Obstetric, Page: 194-98
 www.google//https://respiratory.distress.syndrome.in.com
 national neonatology forum of india. National neonal perinatal
databse-report for 2002-03,
 international organization for standardization. Respiratory tract
humidifier for medical use ,particular requirement for
humidification system.ISO 8185-07

35. .