Respiratory Distress Syndrome🎀
(Hyaline Membrane Disease)
:arrow_right_hook: occurs in premature infants 
↪️60-80% of infants <28 wk of gestational age, in 15-30% of those between 32 and 36 wk of gestational age, and rarely in those
>37 wk of gestational age. 
:arrow_right_hook:The risk 
with maternal DM , multiple births, Cs , precipitous delivery, asphyxia, cold stress, and a maternal history of previously affected infants. 🤦
:arrow_right_hook: risk of RDS is 
in pregnancies with Ch pregnancy-associated HPN, heroin use, PROM, and corticosteroid prophylaxis:chart_with_upwards_trend:
ETIOLOGY
:large_orange_diamond:Surfactant deficiencyis the primary cause of RDS.
Because of immaturity, the amounts produced or released may be insufficient to meet postnatal demands. 
CLINICAL MANIFESTATIONS
Signs appear within minutes of birth, although may not be recognized for several hours in larger premature infants 
A later onset of tachypnea should suggest other conditions. Some patients require resuscitation at birth because of intrapartum asphyxia or initial severe
respiratory distress (especially with a birthweight <1,000 g). 
tachypnea, prominent (often audible) grunting, intercostal and subcostal retractions, nasal flaring, and cyanosis are noted.
Breath sounds may be normal or diminished with a harsh tubular quality, and on deep inspiration, fine crackles may be heard.
untreated RDS is ch.ch by progressive worsening of cyanosis and dyspnea.
If the condition isn’t treated, blood pressure may fall; cyanosis and pallor increase, and grunting decreases or disappears, as the condition worsens. 
Apnea and irregular respirations are
ominous signs requiring immediate intervention. 
Untreated patients may also have a mixed respiratory-metabolic acidosis, edema, ileus, and oliguria. 
Respiratory failure may occur in infants with rapid progression of the disease.
In most cases, the signs reach a peak within 3 days, after which improvement is gradual.
Death can result from severe impairment of gas exchange, alveolar air leaks (interstitial emphysema, pneumothorax), pulmonary hemorrhage, or IVH.
BPD is a form of chronic lung disease that often develops in infants with severe RDS.
DIAGNOSIS
x-ray, the lungs may have a characteristic appearance that include fine reticular granularity of the parenchyma and air bronchograms, more prominent early in the left lower lobe
Laboratory findings are ch.ch initially by hypoxemia and later by progressive be hypoxemia, hypercapnia, and variable metabolic acidosis.
D.D
early-onset sepsis
In neonates with pneumonia, the chest radiograph may be identical to that for RDS. 
Cyanotic heart disease can mimic RDS both clinically and radiographically.
Persistent pulmonary hypertension, aspiration (meconium, amniotic fluid) syndromes, spontaneous pneumothorax, pleural effusions, and congenital anomalies, such as cystic adenomatoid
malformation, pulmonary lymphangiectasia, diaphragmatic hernia, and lobar emphysema, must be considered in patients with atypical clinical course.
Congenital alveolar proteinosis (congenital surfactant protein B deficiency) is a rare familial disease that manifests as severe and lethal RDS in predominantly
term and near-term infants.