Abstract
The management of respiratory distress syndrome (RDS) has advanced because of improvements in mechanical ventilators, promotion of antenatal steroids, availability of surfactant and overall advancements in neonatal intensive care. Intermittent mandatory ventilation still forms the mainstay of assisted ventilation. Newer modes of ventilation have not delivered the results as promised. Because of the continued high incidence of bronchopulmonary dysplasia, there is a renewed interest in non-invasive modes of ventilation like CPAP and nasal IPPV. The present trend is to follow gentle ventilatory strategies accepting higher arterial carbon dioxide and lower oxygen. The role of antenatal steroids has been established beyond doubt but still they fall short of universal acceptance. Surfactant replacement therapy is the standard of care for RDS but beyond the reach of majority in India. Postnatal steroids are out of vogue because of probable links with cerebral palsy and abnormal neurological outcomes.
Article PDF
Similar content being viewed by others
References
Report of the National Neonatal Perinatal Database. National Neonatology Forum, India, 2000.
Lemons JA, Bauer CR, Oh Wet al. Very low birth weight outcomes of the National Institute of Child health and human development neonatal research network, January 1995 through December 1996.Pediatrics 2001; 107(1):el
Avery ME, Mead J. Surface active properties in relation to atelectasis and hyaline membrane disease.Am J Dis Child 1959; 17:517
Papadopoulos MD, Swyer PR. Assisted Ventilation in Terminal Hyaline Membrane Disease.Arch Dis Child 1964; 39:481–484.
Gregory G, Kitterman J, Phibbs Ret al. Treatment of the Idiopathic Respiratory Distress Syndrome with Continuous Positive Airway Pressure.N Engl J Med 1971; 284:1333–1340.
Agostino R, Orzalesi M, Nodari Set al. Continuous positive airway pressure by nasal cannula in respiratory distress syndrome of the newborn.Pediatr Res 1973; 7: 50.
Ho JJ, Subramaniam P, Henderson-Smart DJ, Davis PG. Continuous distending pressure for respiratory distress syndrome in preterm infants.Cochrane Database Syst Rev 2002; (2) : CD002271.
Subramaniam P, Henderson-Smart DJ, Davis PG. Prophylactic nasal continuous positive airways pressure for preventing morbidity and mortality in very preterm infants.Cochrane Database Syst Rev 2000; (2) : CD001243.
Ho JJ, Henderson-Smart DJ, Davis PG Early versus delayed initiation of continuous distending pressure for respiratory distress syndrome in preterm infants.Cochrane Database Syst Rev 2002;(2):CD002975.
Avery ME, Tooley WH, Keller JBet al. Is chronic lung disease in low birth weight infants preventable? A survey of eight centers.Pediatrics 1987; 79:26–30.
Van Marter LJ, Allred EN, Pagano Met al. Do clinical markers of barotrauma and oxygen toxicity explain interhospital variation in rates of chronic lung disease ? The Neonatology Committee for the Developmental Network.Pediatrics 2000; 105:1194–1201.
De Klerk AM, De Clerk RK. Nasal continuous positive airway pressure and outcomes of preterm infants.J Pediatr Child Health 2001; 37:161–167.
De Paoli AG, Morley C, Davis PG. Nasal CPAP for neonates: what do we know in 2003?Arch Dis Child Fetal Neonatal Ed 2003; 88: F168-F172.
Ahluwalia JS, White DK, Morley CJ. Infant flow driver or single prong nasal continuous positive airway pressure: short term physiological effects.Acta Pediatr 1998; 87: 325–327.
Davis PG, Lemyre B, De Paoli AG. Nasal intermittent positive pressure ventilation versus nasal continuous positive airway pressure for preterm neonates after extubation. The Cochrane Library, Issue 1. Oxford: Update Software, 2002.
Cleary JP, Bernstein G, Mannino FL. Improved oxygenation during synchronized intermittent mandatory ventilation in neonates with respiratory distress syndrome: A randomized crossover study.J Pediatr 1995; 126: 407–411.
Donn SM, Sinha SK, Controversies in patient triggered ventilation.Clin Perinatology 1998; 25: 49–61.
Keszler M, Durand DJ. Neonatal High frequency ventilation. Past, Present and Future.Clin Perinatology 2001; 28: 579–607.
Sinha SK, Donn SM. Volume-controlled ventilation. Variations on a theme.Clin Perinatal 2001; 28(3): 547–560.
Herrera CM, Gerhardt T, Claure Net al. Effects of volume-guaranteed synchronized intermittent mandatory ventilation in preterm infants recovering from respiratory failure.Pediatrics 2002; 110:529–533.
Liggins GC, Howie RN. A controlled trial of antepartum glucocorticoid treatment for prevention of the respiratory distress syndrome in premature infants.Pediatrics 1972; 50: 515–525.
Crowley PA. Antenatal corticosteroid therapy: A meta-analysis of the randomized trials, 1972 to 1994.Am J Obstet Gynecol 1995; 173: 322–335.
Doyle LW, Ford GW, Rickards AL, Kelly EA, Davis NM, Callanan Cet al. Antenatal corticosteroids and outcome at 14 years of age in children with birth weight less than 1501 grams.Pediatrics 2000; 106(1): e2
Effect of corticosteroids for fetal maturation on perinatal outcomes. NIH Consensus Development Panel on the effect of corticosteroids for fetal maturation on perinatal outcomes.JAMA 1995; 273 :413–418.
Esplin MS, Fausett MB, Smith Set al. Multiple courses of antenatal steroids are associated with a delay in long term psychomotor development in children with birth weights of less than 1500 g.Am J Obstet Gynecol 2000; 182: S 24
NIH consensus development conference statement on repeat course of antenatal corticosteroids, Aug 17–18, 2000. Williams Obstetrics, 21st edn, Mc Graw Hill, NewYork, 2001; 712.
Knight DB, Liggins GC, Wealthall SR. A randomized controlled trial of antepartum thyrotropin-releasing hormone and betamethasone in the prevention of respiratory disease in preterm infants.Am J Obstet Gynecol 1994 ;171:11–16.
Australian collaborative trial of antenatal thyrotropin-releasing hormone (ACTOBAT) for prevention of neonatal respiratory disease.Lancet 1995; 345 :877–882.
Ballard RA, Ballard PL, Cnaan Aet al. Antenatal thyrotropin-releasing hormone to prevent lung disease in preterm infants. North American Thyrotropin-Releasing Hormone Study Group.N Engl J Med 1998; 338:493–498.
Crowther CA, Hiller JE, Haslam RR, Robinson JS. Australian Collaborative Trial of Antenatal Thyrotropin-Releasing Hormone: adverse effects at 12-month follow-up. ACTOBAT Study Group.Pediatrics 1997; 99: 311–317.
Fujiwara T, Maeta H, Chida S, Morita T, Watabe Y, Abe T. Artificial surfactant therapy in hyaline-membrane disease.Lancet 1980; 1: 55–59.
Phibbs RH, Ballard RA, Clements JAet al. Initial clinical trial of EXOSURF, a protein-free synthetic surfactant, for the prophylaxis and early treatment of hyaline membrane disease.Pediatrics 1991; 88(1): 1–9.
Soll RF, Hoekstra RE, Fangman JJet al. Multicenter trial of single-dose modified bovine surfactant extract (Survanta) for prevention of respiratory distress syndrome. Ross Collaborative. Surfactant Prevention Study Group.Pediatrics 1990; 85(6): 1092–1102.
Suresh GK, Soll RF. Current surfactant use in premature infants.Clin Perinatology 2001; 28: 671–694.
Holm BA, Warring JA. Designer surfactants. The next generation in surfactant replacement.Clin Perinatal 1993; 20 (4): 813–829.
Mukhopadhyay K, Kumar P, Narang A. Role of early postnatal dexamethasone in respiratory distress syndrome.Indian Pediatr 1998; 35:117–122.
Postnatal Corticosteroids to Treat or Prevent Chronic Lung Disease in Preterm Infants American Academy of Pediatrics Committee on Fetus and Newborn Canadian Paediatric Society Fetus and Newborn Committee.Pediatrics 2002 ; 109 : 330–38.
Stevens B, Gibbins S. Clinical utility and clinical significance in the assessment and management of pain in vulnerable infants.Clin Perinatol 2002; 29(3): 459–468.
Kleberg A, Westrup B, Stjernqvist K, Lagercrantz H. Indications of improved cognitive development at one year of age among infants born very prematurely who received care based on the Newborn Individualized Developmental Care and Assessment Program (NIDCAP).Early Hum Dev 2002; 68(2): 83–91.
Northway WH Jr, Rosan RC, Porter DY. Pulmonary disease following respiratory therapy of hyaline membrane disease: Bronchopulmonary dysplasia.N Engl J Med 1967; 176:357–368.
Attar MA, Donn SM. Mechanisms of ventilator-induced lung injury in premature infants.Semin Neonatol 2002; 7(5): 353–360.
Varughese M, Patole S, Shama A, Whitehall J. Permissive hypercapnia in neonates. The case of the good, the bad and the ugly.Pediatr Pulmonol 2002; 33: 56–64.
Stark AR, Carlo WA, Tyson JEet al. National Institute of Child Health and Human Development Neonatal Research Network. Adverse effects of early dexamethasone in extremely-low-birth-weight infants. National Institute of Child Health and Human Development Neonatal Research Network.N Engl J Med 2001; 344(2): 95–101.
Murphy BP, Inder TE, Huppi PSet al. mpaired cerebral cortical gray matter growth after treatment with dexamethasone for neonatal chronic lung disease.Pediatrics 2001; 107(2): 217–221.
Verder H, Albertsen P, Ebbesen Fet al. Nasal continuous positive airway pressure and early surfactant therapy for respiratory distress syndrome in newborns of lass than 30 weeks gestation.Pediatrics 1999; 1103: e24
Bhakoo ON, Narang A, Ghosh K. Assisted ventilation in neonates : An experience with 120 cases. Paper presented at IX Annual Convention of National Neonatology Forum, Manipal, February, 1990; 17–20.
Singh M, Deorari AK, Paul VKet al. Three year experience with neonatal ventilation from a tertiary care hospital in Delhi.Indian Pediatr 1993; 30: 783–789.
Bhakoo ON. Assisted ventilation in neonates: the Indian perspective.Indian Pediatr 1995; 32:1261–1264.
Karthik N, Bhat V, Kunikullaya S, Rajesh N. Surfactant therapy in neonatal respiratory distress syndrome.Indian Pediatr 1994; 31: 971–977.
Narang A, Kumar P, Dutta S, Kumar R. Surfactant therapy for hyaline membrane disease: the Chandigarh experience.Indian Pediatr 2001; 38: 640–646.
Narang A, Kumar P, Kumar R. Chronic lung disease in neonates: emerging problem in India.Indian Pediatr 2002; 39: 158–162.
Kumar P, Malhi P, Singh D, Mahajan R, Narang A. Developmental outcome of ventilated infants. Paper presented at XX Annual Convention of National Neonatology Forum, Mumbai. November 3–5, 2000
Narang A. Neonatal Ventilation. Recommendations of an expert group meeting, Chandigarh. February 20–21, 1993. National Neonatology Forum.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Kumar, P., Kiran, P.S.S. Changing trends in the management of respiratory distress syndrome (RDS). Indian J Pediatr 71, 49–54 (2004). https://doi.org/10.1007/BF02725656
Issue Date:
DOI: https://doi.org/10.1007/BF02725656