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ABC of preterm birth: Respiratory complications of preterm birth

BMJ 2005; 331 doi: (Published 01 July 2005) Cite this as: BMJ 2005;331:0507278
  1. Jenny Fraser, specialist registrar1,
  2. Moira Walls, neonatal nurse1,
  3. William McGuire, senior lecturer in neonatal medicine2
  1. 1Ninewells Hopsital and Medical School, Dundee
  2. 2Tayside Institute of Child Health, Ninewells Hopsital and Medical School, Dundee

Respiratory complications of preterm birth are an important cause of infant mortality and morbidity. This article looks at how advances in perinatal care have improved outcomes for preterm infants with respiratory distress syndrome and chronic lung disease.

Preparation for home oxygen treatment

  • Parental training—how to monitor respiratory status, when to provide extra oxygen, when and where to get help, cardiorespiratory resuscitation

  • Family support—usually from community nurse

  • Risk assessment of the home environment

  • Insurance of car and house

  • Notify fire and ambulance services

  • Financial help—disability parking permits, disability living allowances

Respiratory distress syndrome

Respiratory distress syndrome of prematurity is a major cause of morbidity and mortality in preterm infants. Primarily, respiratory distress syndrome is caused by deficiency of pulmonary surfactant. Surfactant is a complex mixture of phospholipids and proteins that reduces alveolar surface tension and maintains alveolar stability. As most alveolar surfactant is produced after about 30-32 weeks' gestation, preterm infants born before then will probably develop respiratory distress syndrome. In addition to short gestation, several other clinical risk factors have been identified.

Risk factors for respiratory distress syndeome

  • Male sex

  • Caucasian ethnic group

  • Maternal diabetes

  • Perinatal asphyxia

  • Hypothermia

  • Multifetal pregnancy

  • Delivery by caesarean section

Preterm infants with respiratory distress syndrome present immediately or soon after birth with worsening respiratory distress. The presenting features include tachypnoea (respiratory rate > 60 breaths per minute); intercostals, subcostal, and sternal recession; expiratory grunting; cyanosis; and diminished breath sounds.

If untreated, infants may become fatigued, apnoeic, and hypoxic. They may progress to respiratory failure and will need assisted ventilation. High airway pressures may be required to ventilate the stiff, non-compliant lungs, thereby increasing the risk of acute respiratory complications, such as pneumothorax, pneumomediastinum, and pulmonary interstitial emphysema.

Indications for mechanical ventilation in preterm infants with respiratory distress syndrome

  • Hypoxaemia (paCO2 < 50 mmHg)

  • Hypercarbia (paCO2 > 50 mmHg)

  • Acidosis (pH < 7.25)

  • Cardiorespiratory collapse

  • Persistent apnoea or bradycardia

Over the past 20-30 years, two major advances in perinatal …

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