PE19.5 | Neonatal Respiratory Distress — Summary & Reflection

KEY TAKEAWAYS

Neonatal respiratory distress presents with tachypnoea (RR >60/min), grunting, nasal flaring, and chest retractions; the Silverman-Anderson Retraction Score (0–10, based on upper/lower chest, xiphoid retraction, nares dilatation, expiratory grunt) quantifies severity — this is NOT the APGAR score. Three major causes: RDS (surfactant deficiency, preterm <34 weeks, bilateral ground-glass CXR, treat with CPAP and surfactant), TTN (retained lung fluid, term after elective CS, perihilar streaks on CXR, self-limiting in 24–72 hours, supportive treatment), and MAS (meconium aspiration in post-term/MSAF neonates, hyperinflated lungs on CXR, may cause PPHN requiring iNO). Antenatal betamethasone (two doses IM 24 hours apart) given at 24–34 weeks of gestation is the most effective prevention for RDS. Exogenous surfactant (beractant 100 mg/kg or poractant alfa 200 mg/kg via ETT) is the definitive treatment for established RDS. Every neonate with respiratory distress requires CXR, blood glucose, sepsis screen, and SpO₂ monitoring — TTN is a diagnosis of exclusion after sepsis and CHD are considered.

REFLECT

You are working in a district hospital with limited resources — no surfactant, no CPAP machines, no NICU. A 31-week preterm neonate is born with severe respiratory distress. You have supplemental oxygen and a neonatal bag-mask. What improvised measures can you take to keep this baby alive while arranging emergency transfer to a tertiary centre? What does this scenario reveal about the gap between evidence-based medicine and resource-limited reality in India's neonatal care system? How might you advocate for, or contribute to, the introduction of CPAP and surfactant at your facility — and what evidence would you present to the hospital administration?