Respiratory Distress Syndrome of the Newborn--Principles in Treatment

Abstract

By observing the course of the illness in infants with the respiratory distress syndrome, measuring serially the arterial O2-saturation, PCO2, pH and bicarbonate, the nature of the pulmonary disorder and its physiological consequences can be studied. The right-to-left shunt in "normal" premature infants is estimated to average 11%. In severe respiratory distress the shunt increases as the illness progresses. The site of this shunt is discussed. The work of the respiratory muscles in infants with respiratory distress is greatly increased, and survival may depend on the capacity of these muscles to maintain a high rate of work. To provide optimum conditions for the respiratory muscles to work in should, therefore, be the aim of treatment. Oxygen therapy is discussed in terms of the oxygen concentration needed to restore normal arterial saturation. High concentrations up to 90% may be indicated. Oxygen toxicity is considered a lesser danger to the infant in respiratory failure than oxygen lack. Acidosis, whether respiratory or metabolic, should be corrected by infusing sodium bicarbonate with glucose. Humidification reduces water losses from the respiratory tract, and hence also reduces heat losses from the body. To this extent it may be of value. Sternal in-drawing may be treated by sternal traction.