Respiratory Distress Syndrome: Model Clinical Case and Viva QnA

Clinical Case of Respiratory Distress Syndrome

A 28-week gestational age premature infant is born via emergency cesarean section due to maternal preeclampsia. The baby weighs 1100 grams and has an Apgar score of 4 at 1 minute and 6 at 5 minutes.

Immediately after birth, the infant shows signs of respiratory distress:

  • Tachypnea (respiratory rate > 60 breaths per minute)
  • Subcostal and intercostal retractions
  • Nasal flaring
  • Grunting
  • Cyanosis

Initial arterial blood gas analysis reveals:

  • pH: 7.22
  • PaCO2: 65 mmHg
  • PaO2: 42 mmHg
  • HCO3: 18 mEq/L

Chest X-ray shows diffuse ground-glass opacification with air bronchograms, consistent with Respiratory Distress Syndrome (RDS).

The neonatologist initiates treatment with:

  1. Immediate intubation and mechanical ventilation
  2. Administration of exogenous surfactant via endotracheal tube
  3. Oxygen therapy to maintain saturation between 90-95%
  4. Close monitoring of vital signs and blood gases

The infant's condition improves over the next 48-72 hours with continued supportive care and surfactant therapy.



Clinical Presentations of Respiratory Distress Syndrome

  1. Classic Presentation in Premature Infants

    • Onset within minutes to hours after birth
    • Tachypnea (respiratory rate > 60/min)
    • Intercostal and subcostal retractions
    • Nasal flaring
    • Expiratory grunting
    • Cyanosis
    • Decreased breath sounds on auscultation

  2. Mild RDS

    • Mild tachypnea (60-80 breaths/min)
    • Minimal retractions
    • Oxygen requirement < 40%
    • May improve rapidly with CPAP or minimal ventilatory support

  3. Severe RDS

    • Severe tachypnea (> 100 breaths/min)
    • Marked retractions and chest wall instability
    • Persistent cyanosis despite oxygen therapy
    • Decreased urine output due to poor perfusion
    • Apneic episodes
    • Requires intubation and mechanical ventilation

  4. RDS in Term or Near-Term Infants

    • Less common but can occur in infants of diabetic mothers
    • May have delayed onset (12-24 hours after birth)
    • Similar symptoms to preterm infants but often more severe
    • Higher risk of persistent pulmonary hypertension

  5. RDS with Complications

    • Air leak syndromes (pneumothorax, pneumomediastinum)
    • Pulmonary hemorrhage
    • Development of bronchopulmonary dysplasia
    • Associated intraventricular hemorrhage

  6. Atypical RDS

    • Delayed onset (> 24 hours after birth)
    • Worsening symptoms despite initial stability
    • May be associated with sepsis or pneumonia
    • Requires careful differential diagnosis

  7. RDS with Partial Surfactant Deficiency

    • Milder initial symptoms
    • May worsen over first 24-48 hours
    • Often seen in late preterm infants (34-36 weeks gestation)
    • May respond well to non-invasive ventilation and/or single dose of surfactant


Knowledge Check: Question and Answers for Medical Students & Professionals

This interactive quiz component covers essential viva questions and answers. It includes 30 high-yield viva questions with detailed answers.

Question 1 of 30


Disclaimer

The notes provided on Pediatime are generated from online resources and AI sources and have been carefully checked for accuracy. However, these notes are not intended to replace standard textbooks. They are designed to serve as a quick review and revision tool for medical students and professionals, and to aid in theory exam preparation. For comprehensive learning, please refer to recommended textbooks and guidelines.



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