Update on respiratory distress syndrome

  • D. Vidyasagar
Part of the Topics in Anaesthesia and Critical Care book series (TIACC)


Respiratory distress syndrome (RDS), also known as hyaline membrane disease (HMD), is the most common cause of mortality and morbidity in premature infants. Approximately 1% of all newborns world/wide develop RDS. In the USA about 5 000 neonatal deaths/year are due to RDS [1]. Over the last two decades mortality from RDS has dramatically decreased even for extremely premature newborns [2]. Several factors are attributable to improved outcome, and namely: 1) better understanding of lung maturation; 2) improved perinatal management; 3) postnatal use of surfactant as replacement therapy; 4) improved ventilatory management; 5) overall improvement in managing extremely low birth weight infants. This review will highlight the advances in these areas.


Respiratory Distress Syndrome Patent Ductus Arteriosus Lamellar Body Bronchopulmonary Dysplasia Conventional Mechanical Ventilation 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    Wegman ME (1996) Infant mortality: some international comparisons. Pediatrics 96:1020–1027Google Scholar
  2. 2.
    Liechty EA, Donovan E, Purohit D et al (1991) Reduction of neonatal mortality after multiple doses of bovine surfactant in low birth weight neonates with respiratory distress syndrome. Pediatrics 88:19–28PubMedGoogle Scholar
  3. 3.
    Vidyasagar D, Bickers RO, Butterfield J (1998) Publication trends in the field of neonatology. A review of first half century. Pediatr Res 43:329ACrossRefGoogle Scholar
  4. 4.
    Farrell PM, Wood RE (1976) Epidemiology of hyaline membrane disease in the United States: analysis of national mortality statistics. Pediatrics 58:167–183PubMedGoogle Scholar
  5. 5.
    Corbet A, Bucciarelli R, Goldman S et al (1991) Decreased mortality among small premature infants treated at birth with a single dose of synthetic surfactant, a multicenter controlled trial. J Pediatr 118:277–284PubMedCrossRefGoogle Scholar
  6. 6.
    Karlberg P, Cherry RB, Escardo FE, Koch G (1962) Respiratory studies in newborn infants, II. Pulmonary ventilation and mechanics of breathing in first minutes of life, including onset of respiration. Acta Paediat Scand 51:121–26Google Scholar
  7. 7.
    Klaus MH, Clements JA, Havel RJ (1967) Composition of surface active material isolated from beef lung. Proc Natl Acad Sci 47:1858CrossRefGoogle Scholar
  8. 8.
    Hagwood S, Shiffer K (1991) Structures and properties of the surfactant-associated proteins. Ann Rev Physiol 53:375–394CrossRefGoogle Scholar
  9. 9.
    Downes JJ, Vidyasagar D, Morrow GM et al (1970) Respiratory distress syndrome of newborn infants. New clinical scoring system with acid-base and blood gas correlations. Clin Pediatr 9:325–331CrossRefGoogle Scholar
  10. 10.
    Gluck L, Kulovich MV, Borer RC et al (1971) Diagnosis of respiratory distress syndrome by amniocentesis. Am J Obstet Gynecol 109:440–445PubMedGoogle Scholar
  11. 11.
    Harrison VC, Heese H de V, Klein M (1968) The significance of grunting in hyaline membrane disease. Pediatrics 41:549–559PubMedGoogle Scholar
  12. 12.
    Cochrane WD (1976) Umbilical artery catheterization. Report of the 69th Ross Conference on Pediatric Research. Iatrogenic problems in neonatal intensive care. Columbus Ross LaboratoriesGoogle Scholar
  13. 13.
    Huh R, Huch A, Albani M et al (1976) Transcutaneous PO2 monitoring in routine management of infants and children with cardiopulmonary problems. Pediatrics 57:681–690Google Scholar
  14. 14.
    Jennis MS, Peabody JR (1987) Pulse oximetry: an alternative method for the assessment of oxygenation in newborn infants. Pediatrics 79:524–528PubMedGoogle Scholar
  15. 15.
    AGOG Technical Bulletin (1995) Preterm labour. Int Gynecol Obstet 50:303Google Scholar
  16. 16.
    Liggins GC, Howie RN (1972) A controlled trial of antepartum glucocorticoid treatment for prevention of the RDS in premature infants. Pediatrics 50:515PubMedGoogle Scholar
  17. 17.
    Crowley P (1995) Antenatal corticosteroid therapy: a meta analysis of randomized trials, 1972 to 1994. Am J Obstet Gynecol 173:322–334PubMedCrossRefGoogle Scholar
  18. 18.
    NIH Consensus Conference (1995) Effect of corticosteroids for fetal maturation on perinatal outcomes. JAMA 273:413–418CrossRefGoogle Scholar
  19. 19.
    Simpson KN, Lynch SR (1995) Cost savings from the use of antenatal steroids to prevent respiratory distress syndrome and related conditions in premature infants. Am J Obstet Gynecol 173:316–321PubMedCrossRefGoogle Scholar
  20. 20.
    Avery ME, Meade J (1959) Surface properties in relation to atelectasis and hyaline membrane disease. Am J Dis Child 97:517–523Google Scholar
  21. 21.
    Fujiwara T, Chida S, Watabe YJ et al (1980) Artificial surfactant therapy in hyaline membrane disease. Lancet 1:55–59PubMedCrossRefGoogle Scholar
  22. 22.
    Jobe AH (1993) Pulmonary surfactant therapy. N Engl J Med 328:861–868PubMedCrossRefGoogle Scholar
  23. 23.
    Halliday HL (1997) Clinical trials of surfactant replacement in Europe. Biol Neonate 71(Suppl 1):8–12PubMedCrossRefGoogle Scholar
  24. 24.
    Jobe AH, Mitchell BR, Grunkel JH (1993) Beneficial effects of the continued use of prenatal corticosteroid and postnatal surfactant on preterm infants. Am J Obst Gynecol 168:508–513Google Scholar
  25. 25.
    Northway WH, Rosan RC, Porter DY (1967) Pulmonary disease following respiratory therapy of hyaline membrane disease: bronchopulmonary dysplasia. N Engl J Med 176:357–368CrossRefGoogle Scholar
  26. 26.
    Northway WH (1992) Bronchopulmonary dysplasia: twenty-five years later. Pediatrics 89:969–973PubMedGoogle Scholar
  27. 27.
    Philip AGS (1975) Oxygen plus pressure plus time: the etiology of bronchopulmonary dysplasia. Pediatrics 55:44–50PubMedGoogle Scholar
  28. 28.
    Zimmerman JJ (1995) Broncho alveolar inflammatory pathophysiology of bronchopulmonary dysplasia. Clin Perinatol 22:429–456PubMedGoogle Scholar
  29. 29.
    Saldana RL, Cepeda EE, Poland RL (1982) The effect of vitamin E prophylaxis on the incidence and severity of bronchopulmonary dysplasia. J Pediatr 101:89–93CrossRefGoogle Scholar
  30. 30.
    Shenai JP, Chytil F, Stahlman MT (1985) Vitamin A status of neonates with bronchopulmonary dysplasia. Pediatr Res 19:185–189PubMedGoogle Scholar
  31. 31.
    Shenai JP, Kennedy KA, Chytil F et al (1987) Clinical trial of vitamin A supplementation in infants susceptible to bronchopulmonary dysplasia. J Pediatr 111:269–277PubMedCrossRefGoogle Scholar
  32. 32.
    Rosenfeld W, Concepcion L (1986) Endogenous antioxidant defenses in neonates. Free Radic Biol Med 2:295–298CrossRefGoogle Scholar
  33. 33.
    Rosenfeld W, Evans H, Concepcion L (1984) Prevention of bronchopulmonary dysplasia by administration of bovine superoxide dismutase in preterm infants with respiratory distress syndrome. J Pediatr 105:781–785PubMedCrossRefGoogle Scholar
  34. 34.
    Avery GB, Fletcher AB, Kaplan M et al (1985) Controlled trial of dexamethasone in respiratory dependent infants with bronchopulmonary dysplasia. Pediatrics 75:106–111PubMedGoogle Scholar
  35. 35.
    Cummings JJ, D’Eugenio DB, Gross SJ (1989) A controlled trial of dexamethasone in preterm infants at high risk for bronchopulmonary dysplasia. N Engl J Med 320:1505–1510PubMedCrossRefGoogle Scholar
  36. 36.
    Yeh TF, Torre JA, Rastogi A et al (1990) Early postnatal dexamethasone therapy in premature infants with severe respiratory distress syndrome: a double-blind, controlled study. J Pediatr 117:273–282PubMedCrossRefGoogle Scholar
  37. 37.
    Gerdes JS, Harris MC, Polin RA (1988) Effect of dexamethasone and indomethacin on elastosis, L proteinase inhibitor and fibrinectin in bronchoalveolar lavage fluid from neonates. J Pediatr 113:727–731PubMedCrossRefGoogle Scholar
  38. 38.
    Co E, Chari G, McCulloch K et al (1993) Dexamethasone treatment suppresses collagen synthesis in infants with bronchopulmonary dysplasia. Pediatr Pulm 16:36–40CrossRefGoogle Scholar
  39. 39.
    Yeh TF (1996) Prevention of chronic lung disease in premature infants with early dexamethasone therapy procedure of 9th Congress of the Federation of the Asia & Oceania Perinatal Societies. Monduzzi, BolognaGoogle Scholar
  40. 40.
    Avery ME, Mead J (1959) Surface properties in relation to atelectasis and hyaline disease. Am J Dis Child 97:517–523Google Scholar
  41. 41.
    Gregory GA, Kitterman JA, Phibbs RH et al (1971) Treatment of idiopathic respiratory distress syndrome with continuous positive airway pressure. N Engl J Med 284:1333–1340PubMedCrossRefGoogle Scholar
  42. 42.
    Mehta A, Wright BM, Callen K et al (1986) Patient triggered ventilation in the newborn. Lancet 2 (8497):17–19PubMedCrossRefGoogle Scholar
  43. 43.
    South M, Morley CJ (1986) Synchronous mechanical ventilation of the neonate. Arch Dis Child 61:1190–1195PubMedCrossRefGoogle Scholar
  44. 44.
    Bernstein G, Mannino FL, Heldt GP et al (1996) Randomized multicenter trial comparing synchronized and conventional intermittent mandatory ventilation in neonates. J Pediatr 128:453–463PubMedCrossRefGoogle Scholar
  45. 45.
    Vidyasagar D, Chernick V (1972) Continuous positive airway pressure in hyaline membrane disease. Pediatrics 49:144PubMedGoogle Scholar
  46. 46.
    Chernick V, Vidyasagar D (1972) Continuous negative chest wall pressure in hyaline membrane disease: one-year experience. Pediatrics 49:753–760PubMedGoogle Scholar
  47. 47.
    Cvetnic WG, Cunningham MD, Sills JH et al (1990) Reintroduction of continuous negative pressure ventilation in neonates. Two-year experience. Pediatr Pulm 8:245–253CrossRefGoogle Scholar
  48. 48.
    HIFI Study Group (1989) High frequency oscillatory ventilation compared with conventional mechanical ventilation in the treatment of respiratory failure in preterm infants. N Engl J Med 320:88–93CrossRefGoogle Scholar
  49. 49.
    Ogawa Y, Miyasaka K, Kawano T, Imura S, Inukai K et al (1993) A multicenter randomized trial of high frequency oscillatory ventilation as compared with conventional mechanical ventilation in preterm infants with respiratory failure. Early Human Development 32:1–10PubMedCrossRefGoogle Scholar
  50. 50.
    HIFO Study Group (1993) Randomized study of high frequency oscillatory ventilation in infants with severe respiratory distress syndrome. J Pediatr 122:609–619CrossRefGoogle Scholar
  51. 51.
    Greenspan JS, Wolfson MR, Rubenstein D et al (1990) Liquid ventilation of human preterm neonates. J Pediatr 117:106–111PubMedCrossRefGoogle Scholar
  52. 52.
    Leach C, Greenspan JS, Rubenstein SD et al (1996) Partial liquid ventilation with perflubron in premature infants with severe respiratory distress syndrome. N Engl J Med 335:761–767PubMedCrossRefGoogle Scholar
  53. 53.
    Bartlett RH (1990) Extracorporeal life support for cardiopulmonary failure. Curr Probl Surg 27:621–705PubMedCrossRefGoogle Scholar
  54. 54.
    Kinsella JP, Ivy DD, Abman SH (1994) Inhaled nitric oxide improves gas exchange and lowers pulmonary vascular resistance in severe experimental hyaline membrane disease. Pediatr Res 36:402–408PubMedCrossRefGoogle Scholar
  55. 55.
    Schwartz RM, Luby AM, Scanlon JW, Kellogg RJ (1994) Effect of surfactant on morbidity, mortality, and resource use in newborn infants weighing 500 to 1500 g. N Engl J Med 330:1476–1480PubMedCrossRefGoogle Scholar
  56. 56.
    Stahlman MT (1984) The history of hyaline membrane disease: hyaline membrane disease pathogenesis and pathophysiology. Grun & Stratton, New York, pp 1–16Google Scholar
  57. 57.
    Comroe JH (1977) Retrospectroscope. Insights into medical discovery. Von Gehr Press, Menlo Park, CaliforniaGoogle Scholar

Copyright information

© Springer-Verlag Italia 1999

Authors and Affiliations

  • D. Vidyasagar

There are no affiliations available

Personalised recommendations