Respiratory disorder related to a developmental delay in lung maturity, involving widespread alveolar collapse

Most common cause of neonatal death

Affects approximately 10% of all premature neonates

Almost exclusively affects neonates born before the 27th gestational week; occurs in about 60% of those born before the 28th week if untreated antenatally

Most commonly occurs in neonates of mothers with diabetes, neonates delivered by cesarean birth, and neonates with perinatal asphyxia

If mild, subsides slowly after about 3 days

Also called RDS or hyaline membrane disease

In premature neonates, immaturity of alveoli and capillary blood supply leads to alveolar collapse from lack of surfactant (a lipoprotein normally present in alveoli and respiratory bronchioles that lowers surface tension and helps maintain alveolar patency).

Surfactant deficiency causes alveolar collapse, resulting in inadequate alveolar ventilation and shunting of blood through collapsed lung areas (atelectasis).

Inadequate ventilation leads to hypoxia and acidosis.

Compensatory grunting occurs and produces positive end-expiratory pressure (PEEP), helping to prevent further alveolar collapse.

Surfactant deficiency stemming from preterm birth

History of preterm birth, cesarean birth, or other stress during delivery

Maternal history of diabetes or antepartum hemorrhage

Rapid, shallow respirations

Intercostal, subcostal, or sternal retractions

Nasal flaring

Audible expiratory grunting

Pallor

Frothy sputum

Low body temperature

Diminished gas exchange and crackles