10 Causes of Respiratory Distress in Preterm Neonates

• Respiratory Distress Syndrome (RDS):

• Most common cause due to surfactant deficiency in preterm lungs.

• Transient Tachypnea of the Newborn (TTN):

• Due to delayed clearance of fetal lung fluid.

• Pneumonia or Sepsis:

• Acquired infection (in utero, intrapartum, or postpartum).

• Pneumothorax:

• Secondary to RDS or assisted ventilation.

• Apnea of Prematurity:

• Immature central respiratory drive.

• Persistent Pulmonary Hypertension of the Newborn (PPHN):

• Failure of normal circulatory transition.

• Congenital Lung Abnormalities:

• Pulmonary hypoplasia or congenital diaphragmatic hernia.

• Aspiration Syndromes:

• Meconium aspiration, blood, or amniotic fluid aspiration.

• Cardiac Abnormalities:

• Congenital heart defects causing pulmonary congestion.

• Anemia or Polycythemia:
  • Affecting oxygen delivery and blood viscosity.

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Principles of Surfactant Therapy in Preterm Neonates

1. Indications:

• Prophylactic: For neonates <28 weeks of gestation, ideally within 30 minutes of birth.
• Rescue: For neonates diagnosed with RDS, based on clinical and radiological findings.

1. Types of Surfactant:

• Natural: Derived from animal lungs (e.g., poractant alfa, beractant).
• Synthetic: Contains surfactant phospholipids (less commonly used now).

1. Administration:

• Intratracheal instillation via an endotracheal tube.
• Techniques: INSURE (INtubation-SURfactant-Extubation) or minimally invasive surfactant administration (MISA).

1. Monitoring During Therapy:

• Oxygenation and ventilation parameters.
• Risks of complications (e.g., bradycardia, desaturation, pulmonary hemorrhage).

1. Effectiveness:

• Reduces mortality and morbidity related to RDS.
• Decreases ventilator dependency and air leak syndromes.

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Manifestations of Oxygen Therapy in Newborns

Acute Effects

1. Improved Oxygenation:

• Increases arterial oxygen saturation and tissue oxygenation.

1. Potential Complications:

• Hyperoxia: Leads to oxidative stress and free radical formation.
• Hypoxia (if oxygen is insufficient): Worsens metabolic acidosis.

Chronic Effects (Associated with prolonged oxygen therapy)

1. Bronchopulmonary Dysplasia (BPD):

• Chronic lung disease due to prolonged oxygen and ventilator use.

1. Retinopathy of Prematurity (ROP):

• Abnormal retinal vessel growth due to fluctuating oxygen levels.

1. Neurodevelopmental Impairments:

• Oxidative damage to the developing brain.

1. Pulmonary Hypertension:

• Due to vascular remodeling secondary to oxygen exposure.

Monitoring Oxygen Therapy:

• Target SpO₂: 90–95% in preterms to avoid hyperoxia and hypoxia.
• Regular blood gas analysis and pulse oximetry.