Management

If the respiratory distress is mild then the patient should be carefully monitored, ie heart rate, temperature, blood pressure, signs of respiratory distress, fluid balance. Adequate thermoregulation may be obtained in a closed incubator or from an open, radiant heat source incubator.

Interventions that may be required include:-

• ventilation
• fluids: an infant in respiratory distress should not be bottle-fed. In severe respiratory distress fluids are administered intravenously
• acid-base: if there is severe respiratory acidosis (pH less than 7.20 and pCO2 > 60 mmHg) then artificial ventilation may be required. In severe metabolic acidosis sodium bicarbonate infusion may be necessary.
• antibiotics: in infants with respiratory distress where there is a suspicion of infection then antibiotic treatment that combines a penicillin - penicillin G or amoxycillin - and an aminoglycoside, for example gentamicin. Other circumstances when such a regimen may be indicated include the necessity for mechanical ventilation and arterial catheterization.
• extracorporeal membrane oxygenation

Notes:

• early inhaled nitric oxide therapy in premature newborns with respiratory distress
  • low-dose inhaled nitric oxide did not reduce the overall incidence of bronchopulmonary dysplasia, except among infants with a birth weight of at least 1000 g - however there is evidence that it did reduce the overall risk of brain injury (1)
• infants born preterm (before 37 weeks’ gestation) are at high risk of neonatal lung disease and its sequelae
  • the more preterm the baby the greater are the risks, especially when birth occurs before 32 weeks (2)
  • a single course of prenatal corticosteroids reduces the risk of RDS from 26% to 17% (relative risk (RR) 0.66, 95% confidence interval (CI) 0.59 to 0.73) (2)
  • there is evidence that, in women at risk of preterm birth (at ongoing risk of preterm birth at < 34 weeks' gestation)
    • repeat dose(s) of prenatal corticosteroids reduce the occurrence and severity of neonatal lung disease and the risk of serious health problems in the first few weeks of life
    • the review authors conclude that these short-term benefits for babies support the use of repeat dose(s) of prenatal corticosteroids for women at risk of preterm birth. However, these benefits are associated with a reduction in some measures of weight, and head circumference at birth, and there is still insufficient evidence on the longer-term benefits and risks

Reference:

• (1) Kinsella JP et al. Early inhaled nitric oxide therapy in premature newborns with respiratory failure. N Engl J Med. 2006 Jul 27;355(4):354-64.
• (2) Crowther CA, Harding PE.Repeat doses of prenatal corticosteroids for women at risk of preterm birth for preventing neonatal respiratory disease. Cochrane Database Syst Rev. 2007 Jul 18;(3):CD003935