Chapter 18
MEDICAL CONDITIONS IN THE NEONATAL ICU
Utpala Das, MD
Jennifer Leidel, MDI. RESPIRATORY DISTRESS SYNDROME (RDS) & SURFACTANT
ADMINISTRATION
RDS results from lack of active surfactant in lung alveoli. In premature infants, this is
caused by the absence of mature type II cells. Antenatal steroids may be used to
facilitate this maturation. In older infants with RDS, the lack of surfactant may be from a
delay in maturation of type II cells as seen in infants born to diabetic mothers. Other
causes of RDS stem from a relative lack of surfactant in alveoli such as inactivation
from cytokines in infection (sepsis, pneumonia) or chemical inactivation (meconium
aspiration). Production may also be impaired by hypothermia, hypovolemia, hypoxemia
and acidosis.
Symptoms result from low long volumes which lead to increased alveolar surface
tension and collapse. This manifests as poor compliance, decreased FRC and
worsening work of breathing. Clinically, infants have tachypnea, ↑ respiratory effort,
hypoxemia, hypercapnia and/or respiratory failure. On CXR, air bronchograms and a
“ground glass” appearance of the lung fields may be seen. However, these may also be
found in TTN, aspiration syndromes and congenital pneumonia.