Dr Kola Tytler MBBS CertHE MBA MRCGPClinical Lead • iatroX
When managing infants with respiratory distress syndrome (RDS), it is important to monitor for potential complications, both long-term and acute.
- Bronchopulmonary Dysplasia (BPD): A significant long-term complication to monitor for is bronchopulmonary dysplasia (BPD), a chronic lung disease NICE NG124. Risk factors for BPD include lower gestational age, lower birthweight, invasive ventilation begun within 24 hours of birth, clinical sepsis, and treatment with surfactant or for a patent ductus arteriosus (PDA), which often reflect the severity of the baby's condition NICE NG124. Dexamethasone may be considered to reduce the risk of BPD in preterm babies who are 8 days or older and still require invasive ventilation NICE NG124.
- Acute Respiratory Deterioration and Failure: Monitor closely for signs of worsening respiratory distress or impending respiratory failure NICE CKS. These include:
- Severe Respiratory Distress: Look for grunting, marked chest recession, nasal flaring, or a respiratory rate over 60 breaths/minute NICE CKS,NICE CKS. Moderate or severe chest indrawing is also a sign NICE CKS.
- Hypoxia: Signs of hypoxia can include agitation, behavioural changes, cyanosis (bluish lips or extremities), or pallor NICE CKS,NICE CKS. Persistent oxygen saturation of less than 92% when breathing air is a concern NICE CKS.
- Impending Respiratory Failure: Be aware of listlessness, decreased respiratory effort, recurrent apnoea, or failure to maintain adequate oxygen saturation despite oxygen supplementation NICE CKS.
- Altered Consciousness and Activity: The infant may appear seriously unwell, not wake, or if roused, not stay awake, or show decreased activity and no response to social cues NICE CKS,NICE CKS.
- Feeding Difficulties: Difficulty with breastfeeding or inadequate oral fluid intake (50–75% of usual volume) can indicate deterioration NICE CKS.
- Patent Ductus Arteriosus (PDA): A PDA can become a significant clinical problem, for example, causing difficulty weaning the baby from a ventilator, and should be monitored in this context NICE NG124.
- Physiological Parameters: Continuous pulse oximetry should be used to measure oxygen saturation, aiming for 91% to 95% after initial stabilisation NICE NG124. For preterm babies on invasive ventilation, carbon dioxide partial pressure (PCO2) should be monitored, aiming for specific ranges NICE NG124. Blood pressure should also be monitored, especially if dexamethasone is used, due to the risk of hypertension NICE NG124.