Respiratory distress syndrome

Not too long ago, we had a case of Respiratory distress syndrome in a VLBW baby which sadly didn't end well. On reviewing the case, I wondered what might have been done differently.

This was a 28 wk GA VLBW baby brought in about 2 hrs after birth with respiratory distress. The mother had not attended any antenatal services. Initially the mgt was geared towards managing a preterm baby and possibly sepsis, the usual, with oxygen instituted but after about a week or so on admission, was still in distress, even more so, with reducing oxygen saturation despite been on oxygen. At this point, we entertained RDS as a possible diagnosis.

We couldn't carry out any investigations since JOHESU are on strike. But then again, what possible investigation can one do to confirm RDS in our setting in a week old neonate? A CXR in that critical state to reveal a fine reticular granular appearance (ground glass) plus air bronchogram (cos of the aerated bronchioles meeting the collapsed alveoli) and poor expansion is not pathognomonic of it since a Gp B strep pneumonia will show a similar picture. We don't do blood gases to detect acidosis, low PaO2 and high PCO2 and already our pulse oximeter had showed a poor oxygen saturation earlier. So, we settled for clinical diagnosis evidenced by Progressive signs of respiratory distress and physical signs of prematurity. Now, coming to the management and the reason I shared this case scenario. Asides from carrying out the usual mgt of caring for a preterm ie taking care of hypothermia, hypoglycemia, electrolyte disturbances etc. It is advocated to give surfactant via an endotracheal tube a few hours after birth prophylactically or some days later as early rescue.

Sadly, since this is largely unavailable and expensive in our environs, the primary therapeutic modality for RDS in now tending towards Continuous Positive Airway Pressure(CPAP) to be specific BUBBLE CPAP for poor settings.

Bubble CPAP is appealing because of its simplicity and low cost. It is also associated with a decreased incidence of bronchopulmonary dysplasia (BPD) compared to mechanical ventilation. It has been demonstrated to lead to a marked reduction in respiratory distress syndrome mortality. CPAP keeps the alveoli open at the end of expiration, decreasing the right-to-left pulmonary shunt.