Respiratory support, surfactant therapy, and Downe scoring in neonatal RDS
THE CONTEXT
Management of neonatal respiratory distress syndrome (RDS) includes respiratory support and surfactant replacement, with attention to pressure-related and oxygen-related injury.
Respiratory support and injury
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Continuous positive airway pressure (CPAP) minimizes lung injury, air leaks, and sepsis.
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Preterm neonates with severe RDS often require mechanical ventilation.
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Excessive pressure and high oxygen can injure preterm lungs.
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Oxygen saturations above 95% can contribute to retinopathy of prematurity, which can cause blindness.
Surfactant replacement
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Exogenous surfactant replacement therapy is the treatment of choice for moderate to severe RDS.
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Current natural surfactants are extracted from animal lungs: beractant from bovine calves and poractant from pigs.
Downe score
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The score assesses respiratory rate, cyanosis, grunting, retractions, and air entry.
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A score greater than 6 suggests impending respiratory failure.