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1、Neonatal Respiratory Distress Syndrome NRDS新生儿呼吸窘迫综合征,Pediatric department of First Affiliated Hospital of Shantou university medical collegeLin Niyang,Definition,Hyaline membrane disease，HMDDeficiency of pulmonary surfactant，PSPulmonary alveoli collapse at the end of expirationProgressively aggrava
2、ted respiratory distress shortly after birthMainly in preterm infantHigher incidence rate with smaller gestational ageInfant of DM mother,cesarean section,the second baby of twins,Etiology,PS are secreted by type II epithelial cells of pulmonary alveoli.Dipalmitoyllecithin（DPPC）is the main substance
3、.Surfactant protein（SP）PS are produced from 1820w till 3536w when lung is mature.,Etiology,PS cover the inner surface of pulmonary alveoli,which can:decrease alveolar surface tensionprevent alveoli collapse at the end of expirationkeep functional residual capacity（FRC）keep stable pulmonary alveolus
4、pressure decrease fluid exude from capillary to pulmonary alveoli,Etiology,Preterm birthpH of body fluid,body temperature,volume of pulmonary blood flow and hormone can influence PS secretion.Asphyxia,hypothermia,placenta previa,placental abruption and hypotension of mother,which can influence blood
5、 flow of fetus.High level insulin of IDM may resist the promotion effect of adrenal cortex hormone to PS synthesis,Pathogenesis,PS deficiency,alveolar surface tension,alveolus collapse and pulmonary compliance,work at inspirationdifficulty at alveolus opening,tidal volume,alveolar ventilation,CO2 re
6、tention,respiratory acidosis,V/A,hypoxia,metabolic acidosis,Alveolar permeability,interstitium edema,fibrin deposition in the inner surface of alveoli,eosinphilic hyaline membrane,gas diffusion disorder,Clinical manifestation,Respiratory distress 26h after birth:dyspnea,cyanosis,flaring of alaenasi,
7、inspiratory three-concave sign,expiratory groanProgressively aggravated respiratory distressFlat thorax,low breath sound,wet ralesArterial duct opening at convalescence stageCondition will improve after 3d but the course will longer if complications exist.,Assistant examination,Laboratory examinatio
8、ns：foam testlecithin/sphingomyelin（L/S）blood gas analysisChest X ray：frosted glass-like changesair bronchogramwhite lungcolor Doppler ultraphonic：PPHN,PDA,Diagnosis,Clinical manifestationsChest X ray,Differential diagnosis,wet lunggroup B streptococcal pneumoniadiaphragmatic hernia,Therapy,General t
9、reatment：incubationmonitoring of T,R,HR,BP,blood gasliquid and nutrition SupplyRectification of acidosisshut off arterial ductusantibiotics,Oxygen therapy and assistant ventilation：oxygen inhalansconstant positive airway pressure(CPAP)ventilationcommon frequency ventilatorhigh frequency oscillation
10、ventilator,high frequency ejection ventilatorextracorporeal membrane oxygenator(ECMO),Therapy,Therapy,PS substitution therapy：Natural,semisynthesis,artificial synthesisutilization：pump into airway through intra-tracheal tube within 24h after birth Repeat 24 times if requirement,Prevention,Prevention of preterm laborPromotion of fetal lung maturityProphylactic using PS,Summary,
