Overview
Definition
A respiratory disorder in premature infants caused by surfactant deficiency, leading to alveolar collapse and progressive atelectasis.
Epidemiology
Affects primarily preterm infants; incidence is inversely proportional to gestational age (affects ~60% of babies born <28 weeks).
Etiology & Risk Factors
- Surfactant deficiency (produced by Type II pneumocytes, starts at ~24-28 weeks, mature by 35 weeks)
- Associated with maternal diabetes (insulin inhibits surfactant production)
Clinical Symptoms
- Presents immediately after birth or within hours
- Tachypnea, nasal flaring, grunting (forced expiration against closed glottis to maintain PEEP)
- Intercostal and subcostal retractions
- Cyanosis
Clinical Approach
Diagnosis
- Chest X-Ray showing classic diffuse 'ground-glass' appearance with air bronchograms and low lung volumes
- ABG showing hypoxia, hypercapnia, and respiratory acidosis
Management
- Maternal administration of antenatal corticosteroids (Dexamethasone/Betamethasone) to mothers at risk of preterm delivery (to accelerate fetal lung maturity)
- Intratracheal surfactant administration to newborn
- Continuous Positive Airway Pressure (CPAP) or mechanical ventilation
Complications
- Bronchopulmonary Dysplasia (chronic lung disease)
- Pneumothorax
- Intraventricular Hemorrhage
- Patent Ductus Arteriosus