Newborn respiratory distress syndrome: from embryonic development to the intensive care management

Abstract

The birth of a premature baby carries important repercussions for the health system, since its complications are closely associated with infant mortality. Respiratory pathology stands out for being the main cause of morbidity and mortality in these patients, being the Respiratory Distress Syndrome due to surfactant deficiency the pathology that occurs most frequently. The pathophysiological substrate of this disease is the qualitative and quantitative deficiency of lung surfactant, a complex of phospholipids and proteins that reduces surface tension within the alveoli. The immature lung, which lacks the adequate levels of this substance, suffers from collapse of the alveolar structures, which avoids an adequate gas exchange and ends in low levels of oxygen in the blood. The initial suspicion is purely clinical, with signs of respiratory distress that can be easily identified from the delivery room, the most notable of which are: tachypnea, nasal flaring, expiratory whining and intercostal, subcostal and subxiphoid retractions. The diagnosis is integrated with a chest x-ray, which tends to show a classic reticulogranular pattern with ground glass appearence. The management of these patients focuses on three pillars, the central one being the induction of lung maturation with the administration of corticosteroids to pregnant women at risk of preterm delivery. In addition to this, the use of positive pressure and exogenous surfactant has completely changed the prognosis of these patients, which is increasingly promising.