Stages of respiratory distress syndrome in newborns | Neonatal respiratory distress syndrome

Stages of respiratory distress syndrome in newborns

In order to objectify the severity of the respiratory distress syndrome, it has been divided into four stages. Stage I describes the mildest clinical picture, stage IV the most severe. No clinical symptoms are used for classification, as these vary individually in newborns.

The stages are diagnosed exclusively on the basis of the radiological findings of the X-ray. To be more precise, it is assessed how large the proportion of alveoli is that have already collapsed, which as a result are no longer available for gas exchange. Since a higher stage means less lung tissue still usable, statistically it also has a worse prognosis.

X-ray image for the diagnosis of a respiratory distress syndrome in newborns

An x-ray is essential to confirm the diagnosis and to further classify the stages of the disease and should therefore be taken if respiratory distress syndrome is suspected. Of course, the radiation exposure must also be considered. However, the radiation exposure is now rather low in the case of X-rays, so that the benefit of confirming the diagnosis and the then possible targeted treatment of the respiratory distress syndrome can usually be estimated to be greater.

The stages are classified according to the degree of “shading”, i.e. the proportion of lung tissue that appears white in the X-ray image. The whiter the lung appears in the X-ray image, the more impermeable the tissue was to X-rays, as it already contains many collapsed alveoli, which make the tissue denser. The highest (IV.) stage of this disease is therefore sometimes called “white lung”.

Associated symptoms of respiratory distress syndrome in children

In a respiratory distress syndrome, the first thing you notice are the symptoms that characterise respiratory distress. These include nostrils, rapid breathing and bluish lips or mucous membranes. Since IRDS is more common in premature babies, other immature signs can occur in the child, such as poorly developed subcutaneous fatty tissue, an insufficiently developed immune system or lanugo hair, the so-called downy hair, which serves as temperature insulation before birth.

Therapy of a respiratory distress syndrome in newborns

Ideally, the treatment of IRDS should begin in the womb: If premature birth is imminent, surfactant production must always be stimulated by medication. This is done by the administration of glucocorticoids, molecules closely related to cortisone. These ensure that a sufficient amount of surfactant is produced within 48 hours.

Often this therapy is combined with an inhibitor of contractions, if the contractions have already started. This allows enough time to allow the glucocorticoid to take effect. If, on the other hand, a respiratory distress syndrome is detected in the child already born, certain immediate measures must be taken at the appropriate birth centre: Since the child’s lungs are always in danger of collapsing, the pressure in the lungs must be maintained with the help of a beaming mask that sits firmly on the face.

You should be supplied with sufficient oxygen, but not too much, as too much oxygen is harmful to newborns. It may also be considered whether adding the missing surfactant is helpful in individual cases. This is then brought in liquid form directly into the trachea, from where it can be distributed via the bronchial tubes into the pulmonary alveoli.