Respiratory distress syndrome (RDS) refers to any pathological changes in the lungs, occurring in the fetus or newborn in the first 2-3 days of life, clinically manifested by severe respiratory failure.
SDR is more often observed in premature babies, especially twins, mainly in boys. The main causes of its occurrence are: a) pneumopathy - lungs, hyaline membranes, edematous-hemorrhagic syndrome, hemorrhage in the lungs, lung malformations; ) intrauterine - , sepsis; intracranial hemorrhages.
The anatomical and functional maturity of the lungs depends on the amount of surfactant that lines the inner surface of the alveoli, creating a superficial alveolar film that prevents the collapse of the alveoli and the development of atelectasis. For normal lung functioning, a sufficient amount of surfactant is achieved by the 35th week. its content in the fetal lung tissue can be determined by the level of lecithin in the amniotic fluid. For this purpose, the Clements foam test is used. Its essence is as follows.
The “foam” test is also carried out with the contents of the newborn’s stomach. SDR is most evident in the first 2 days of life and gradually disappears by the 12-14th day. Its severity is assessed on the Silverman scale 30 minutes after the birth of the child, then after 3-6-12 hours for 2-3 days. and scores indicate the presence of the syndrome. With a score of 10, the child’s condition is extremely serious.
Silverman scale
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Clinical symptoms |
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Uneven |
Paradoxical |
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Intercostal space retraction |
Absent |
Moderate |
Sharply expressed |
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Sternal retraction |
Absent. |
Moderate on inspiration |
Constant, pronounced |
Signs of SDD are observed in the first life of a child. These include: increased breathing (over 60-70 per minute), retraction of the intercostal spaces when inhaling and xiphoid process, flaring of the wings of the nose, difficulty exhaling, functional state central nervous system.
Primary atelectasis can be small, scattered throughout both lungs or grouped into large conglomerates occupying several segments (polysegmental atelectasis).
Children become lethargic, there is a decrease in muscle tone and adynamia. A sharp feeling appears, breathing becomes rapid and difficult, paradoxical, like a “swing”. The chest is barrel-shaped and rigid on palpation. There is a dullness or shortening of the percussion sound and weakened breathing on the affected side, hard, increased breathing on the remaining parts of the lungs. Single, intermittent crepitating rales may be heard. Uncomplicated pathological process collapsed lung tissue straightens out within 4-5 days. Scattered disseminated atelectasis are more often primary and are observed in children with low weight and immature lung tissue. are often born in a state of asphyxia, lethargic, with reduced muscle tone, pronounced cyanosis. The respiratory disorder syndrome is initially mildly expressed, on 2-4 points on the Silverman scale, but by the end of 2-3 days the height of the disease occurs. becomes more frequent, the nostrils flare, convulsive sighs appear. The chest is “testy” to the touch. The percussion sound is shortened throughout or by separate areas lungs. hard, difficult sonorous exhalation, against the background of which isolated intermittent crepitating wheezes are heard. At favorable course on the 5th it begins and by the end of the 2nd week the symptoms gradually disappear. Acute condition on the 5-6th day is a sign of pneumonia.
Children with hyaline membrane syndrome may be born in a satisfactory condition. the interval sometimes lasts up to 12 hours, after which severe respiratory failure, breathing quickens, skin cyanosis appears, which does not disappear with oxygen inhalation. Repeated attacks of asphyxia are observed; dense, increased in size; the subcutaneous base grows. On auscultation, the lungs are weakened and small wheezing can be heard. Subsequently, the functions of central, complete and frequent cessation of breathing are noted. pale with a grayish-cyanotic tint.
Edema-hemorrhagic syndrome- one of the most severe forms of pneumopathy. It is a local manifestation of pathological hydration of the whole organism of a newborn, which occurs as a result of a violation metabolic processes and intrauterine asphyxia. A characteristic feature syndrome is the discharge of foamy bloody fluid from the mouth. Respiratory and signs of SDR appear at birth. Extensive hemorrhages often occur on the skin and subcutaneous tissue. Severe edema is observed in the lungs: upon percussion, the sound is shortened and weakened, especially in lower parts, listened to large number- and fine bubbling wheezing.
Edema-hemorrhagic syndrome is almost always combined with disseminated pulmonary atelectasis, especially in premature infants.
Hemorrhages in can be alveolar, interstitial and mixed. In 50% of cases it is noted
Terms of respiratory distress syndrome (RDS), respiratory distress syndrome(RDS) and hyaline membrane disease (HMD) in foreign literature- synonyms. For example, in the most popular neonatology manuals in the United States, terms are used to describe the same condition (disease): in the 7th edition of Averys Diseases of the Newborn (1998) - hyaline membrane disease, and in the 7th edition Neonatal-Perinatal Medicine (Ed. A.A.Fanaroff and R.J.Martin, 2002) - respiratory distress syndrome. We prefer the concept of respiratory distress syndrome.
The frequency of development of SDR on average depends on the degree of prematurity of the newborn and is on average 82-88% for the birth of a child at a gestation period of less than 27 weeks, 78-80% - at a period of 27-28 weeks, 70% - at a period of 29 -30 weeks, 50-55% - for a period of 3 1 - 3 2 weeks, 20-22% - for a period of 33-34 weeks, 5 - 1 0% - for a period of 35-36 weeks. and less than 1 - 2% - at a gestational age of 37 weeks. and more.
HDM (type I SDR, RDS) and its consequences are the cause of 30-50% of neonatal deaths.
Etiology. Causal factors development of B GM are:
deficiency of surfactant formation and release;
quality defect of surfactant;
inhibition and destruction of surfactant;
immaturity of the lung tissue structure. All these processes are facilitated by:
prematurity;
intrauterine infections;
perinatal hypoxia, asphyxia and the resulting pulmonary ischemia and acidosis;
retinopathy of prematurity;
Movement disorder syndrome is one of the childhood diseases that lately are becoming more common in newborns. For many parents, this diagnosis causes despair, since until recently the disease was little studied, which means its treatment was almost impossible.
The syndrome becomes known already in the first weeks of a child’s life. And if doctors begin to suspect its presence not in the maternity hospital, then parents definitely see some deviations in the development of their baby. And the sooner this happens, the greater the likelihood that further development the disease can be avoided, in addition, the symptoms that are already appearing can be quickly eliminated.
This is why it is so important to monitor your baby and promptly tell the doctor about any abnormalities. But for this you need to know exactly how the syndrome manifests itself. movement disorders(SDR) in newborns, and what signs may indicate the presence of this disease.
Movement disorder syndrome is a pathology motor activity. It can be expressed in different ways, and the disease is classified depending on the age of the patient. Accordingly, the treatment of this disease may be different.
There are three types of violations: 
In addition, it should be noted that the disease can occur in both infants and older children. In the first case, its cause is negative impact on the fetus during its stay in the womb. In addition, the cause may be injuries acquired during the passage of the fetus through the birth canal during childbirth.
In adulthood, the disease is of a different nature. Its cause is age-related changes or illness, as well as injury.
Symptoms of the disease also manifest themselves differently. IN in this case It is worth paying more attention to infantile movement disorder syndrome.
Lack of treatment can cause a more serious illness, even. This is why parents should pay attention special attention child development from a very early age.
Symptoms of paresis can be expressed in weakening of motor activity of the limbs. A doctor can determine the symptoms, 
the observer of the baby and the parents. If a child is lethargic, his limbs have decreased activity.
In addition, paralysis of the laryngeal muscles in children is quite often observed, as a result of which the child’s swallowing reflex is disrupted from a very early age. This symptom indicates a serious stage of the disease, requiring immediate treatment, and eliminating such dangerous symptoms.
You should pay special attention to how promptly the child develops, that is, begins to hold his head, consciously touch objects surrounding him, and so on.
In case of serious deviations from the schedule, you must immediately indicate this fact doctor observing the baby. The fact is that movement disorder syndrome in children, if left untreated, often leads to serious problems in the development of the child. They can be both physiological and mental in nature.
The presence of this disease in a child leads to impaired motor abilities. As a result, it is impossible to begin to roll over onto the tummy from the back in time, to hold the head independently, to learn the world around us by touching and so on.
In this case, a simple example should be given: if the baby begins to hold his head independently at 3-4 months with normal development, then if he has movement disorder syndrome, he may not be able to cope with this task even at one year old. This indicates the ability to sit, stand and walk independently.
Despite the fact that it is the doctor who must notice disturbances in the physiological development of the child, first of all the parents themselves should pay attention to this factor special attention, at least until the baby is one year old.
In order for parents to be able to pay attention to certain disorders in the baby’s development in a timely manner, it is worthwhile to clearly know what exactly the symptoms of motor disorders in an infant may manifest. They may be of the following nature:
It can be noted that, in general, children who have a syndrome of motor disorders are weaker, lethargic and phlegmatic than their healthy peers. When identifying such signs, you should not rush to attribute them to the baby’s personality traits, but instead, you should bring this to the attention of your pediatrician.
Parents should communicate a lot with their children, constantly watching them. It is imperative to draw parallels with their peers in order to be able to objectively assess the development of your child. 
It is worth noting that the syndrome can manifest itself not only in physical, but also in mental disorders from the norm. So small child can independently pick up toys, but at the same time does not understand what to do with them.
And if healthy child realizes such moments quickly enough, then those who have severe symptoms deviations may take much longer.
If the child has visual disturbances, then he will be confused in space, it is more difficult for him to determine where this or that object is located. If the baby cannot reach the desired object with his hands the first time, you should immediately sound the alarm and report the symptom to the doctor, while simultaneously observing the child’s general behavior.
Dr. Komarovsky about neurological problems and movement disorder syndrome in our children:
The complexity of treatment, as a rule, depends on how early the symptoms of the disease are detected. Today there are effective techniques, capable of eliminating the disease quite effectively and relatively quickly.
After qualified treatment children grow up completely healthy, and the symptoms of the disease completely disappear.
Most often, a complex of therapeutic measures is used for movement disorder syndrome:
However, it has proven to be best in the treatment of movement disorder syndrome. therapeutic massage. It is this that allows not only to eliminate the symptoms of the disease, but also generally stimulates physical development children.
You should not fall into despair if your child is diagnosed with SDD. The disease is treatable, and the sooner it is detected, the easier and more effectively it will be eliminated. In this case, much depends on the observation of the parents and the professionalism of the doctor caring for the child.
How effective the treatment will be depends, first of all, on the complexity and degree of neglect of the disease. If noted light form syndrome, then when proper treatment It can be overcome already in the first year of the baby’s life.
More advanced stages often cause serious motor and mental disorders. These include:
IN early age Attentive attitude towards the child is extremely important. It consists in providing freedom in development, naturally - within reasonable limits.
You cannot limit your baby's space to a crib or playpen. It is advisable to allocate a separate room for the child, in which he can move freely, subject to safety measures.
Bright pictures, educational toys, barefoot walking and fitball - all this contributes to proper development baby and is a means of preventing movement disorder syndrome.
IN recent years much attention is paid drug prevention SDR. It has been proven that it is possible to delay the onset of labor in women with threatened miscarriage and to activate the synthesis of surfactant in the fetus with glucocorticoids, β-mimetics and other drugs.
However, a number of authors warn against wide application corticosteroids due to possible complications. Unsatisfactory results were obtained when prescribing hormonal drugs to women with toxicosis of pregnancy, diabetes mellitus, kidney diseases.
A more universal and reliable prevention of SDR is to carry out extensive events for the prevention of prematurity, treatment of acute and chronic diseases in women, timely prevention and treatment of toxicosis in pregnant women, organization intensive care and care for mothers in labor premature birth, development of optimal methods of delivery. In the delivery room, along with maintaining optimal sanitary-epidemiological and temperature conditions, it is necessary to prepare everything for the provision of emergency care newborn.
The air temperature in the room should be 22-24° C, and around the child at the time of birth, depending on the degree of maturity, 26-32° C, since hypothermia sharply increases the need for oxygen due to an increase in the rate of metabolic processes.
The complex of resuscitation benefits is determined by the functional state of newborns, their adaptive capabilities and aims to restore and compensate for impaired or lost functions.
In specialized maternity hospitals, if there is a neonatologist on duty, the child should not be detained in the delivery room. After resuscitation measures children with an Apgar score of 6-7 points are transferred to the intensive care ward, and with a score below 5 points - to the intensive care ward. In the incubators, the air temperature is maintained at 32-34° C and humidity at 60-90%. The child is naked in the incubator, which makes it easier to observe changes in the color of his skin, breathing rhythm, activity and allows timely assistance to be provided if necessary.
Children who do not maintain the newborn position are given a comfortable position with the help of special bolsters and pads that prevent the development of aspiration, respiratory distress (twisting and bending of the neck), bedsores, and edematous changes. It is necessary to exclude painful stimuli and temperature fluctuations environment, sudden movements. Periodically change the position of the child in the incubator or bed. Changing position helps improve respiratory and circulatory function. If a newborn has frequent regurgitation or vomiting, it is recommended to place him in a position in the incubator (crib) half-turned on his side with an elevated top part torso.
The duration of a child’s stay in an incubator is determined individually, taking into account the functional state and ability of his body to maintain a body temperature of 36-37 ° C, with gradual adaptation to being in bed.
Start time single dose, frequency and feeding method are determined individually, taking into account the condition and severity of SDR.
In order to monitor the adequacy of feeding, nutrition calculations are carried out. The most reasonable is the calculation of nutrition taking into account the severity of the condition in terms of calorie content, according to which premature baby in the first 3 days of life should receive no more than 125.52-250.04 kJ/kg of body weight, by the 7-8th day of life 293.0-334.9 kJ/kg and by the 10-14th day 418, 6,502.3 kJ/kg. As a drink in the first days of life, Ringer's solution with 5% glucose solution is prescribed in a ratio of 1: 3. The daily amount of liquid, including milk, is 70-80 ml/kg for children weighing less than 1500 g and 80-100 ml/kg with body weight more than 1500 g.
In newborns with SDR caused by immaturity of the lungs, atelectasis, edematous-hemorrhagic syndrome, hyaline membrane disease and other causes, in the complex of intensive care, measures aimed at restoring respiratory and circulatory function, replenishing blood volume, improving its rheological properties and microcirculation are of leading importance. correction of metabolic and enzymatic disorders, adequate oxygen therapy.
Oxygen must be heated and sufficiently humidified, regardless of the method of its introduction. Dry and cold oxygen increases the evaporation of fluid from the vast surface of the mucous membranes and heat loss, and contributes to the thickening of secretions. It is advisable to use as much as possible low concentrations oxygen, allowing you to maintain P^> not lower than 6.67-8.00 kPa (50-60 mm Hg) and constantly monitor blood gases.
When carrying out oxygen therapy, it is necessary to constantly monitor the free patency of the respiratory tract, for which every 2 hours (and if necessary more often) the contents are aspirated from oral cavity and nasopharynx, and if necessary - from the trachea. After aspiration of contents from the trachea into mandatory perform auxiliary ventilation of the lungs with 60% oxygen for 3-5 minutes using a mask or an Ambu apparatus.
For children with stage I SDD, oxygen therapy can be administered through a nasal catheter.
The oxygen concentration should not exceed 60%. To do this, use oxygen tents or a plastic bag without creating resistance when exhaling.
Most effective method the fight against arterial hypoxemia, which develops in SDR due to disruption of the ventilation-perfusion relationship and diffusion capacity of the lungs, is spontaneous breathing with constant positive pressure.
Ineffective spontaneous breathing frequent attacks apnea, sharp violation CBS and blood gases are indications for mechanical ventilation.
For pulmonary edema, in addition to spontaneous breathing with constant positive pressure, inhalation of oxygen passed through 20-40% alcohol or antifomsilane is indicated, intravenous administration 2.4% aminophylline solution at the rate of 0.1 ml/kg body weight, concentrated solutions plasma or albumin, diuretics (lasix 1-2 mg/kg, mannitol 0.5-1 g/kg, uregit 1.5-2 mg/kg body weight), glucocorticoids (hydrocortisone 5-10 mg/kg, prednisolone 1- 2 mg/kg body weight). Mannitol is administered intravenously over 15 minutes; its volume should be taken into account in the total volume of fluid calculated for the day.
In addition, cardiac glycosides are recommended - 0.05% solution of strophanthin K or 0.06% solution of corglycone at the rate of 0.01 mg/kg or 0.02 ml/kg of body weight 1 to 3 times a day; Digoxin 0.05 mg/kg per day (saturation dose) according to the generally accepted regimen.
Along with oxygen therapy, treatment is carried out aimed at correcting hemodynamic and metabolic disorders. Rheopolyglucin (10-15 ml/kg), albumin or plasma (10-15 ml/kg) and 10% glucose solution to the full volume are used as colloidal solutions. The ratio of colloids to crystalloids is 1:1 or 1:2. The rate of fluid administration is determined by specific situation. If it is necessary to quickly replenish the bcc, the starting solution is administered within 15-20 minutes; ‘/z daily amount liquid for 3-4 hours, and then at a rate of 1-2 drops per 1 minute per 1 kg of body weight. Sodium bicarbonate is used only under the control of CBS indicators. Cocarboxylase is added to the dropper, ascorbic acid, ATP, aminophylline.
On the 2nd day of life, the volume of fluid is increased from 30-65 to 80 ml/kg body weight, taking into account feedings. As crystalloid solutions, along with glucose, Ringer's solution is administered in a 1:1 ratio. If there is adequate diuresis and the ability to determine electrolytes, starting from the 2-3rd day, potassium deficiency is compensated for with a 7.5% solution of potassium chloride containing 1 mmol of potassium in 1 ml, which is administered intravenously in a glucose solution.
On the 3rd day of life, the volume of fluid is increased to 100-120 ml/kg, taking into account the severity of the disease and feedings. During infusion therapy, diuresis must be monitored.
In children with SDD that developed due to damage to the central nervous system of a hypoxic or traumatic nature, therapy is aimed at reducing and eliminating hypoxic syndrome and cerebral edema, restoring the neuro-reflex and trophic functions of the central nervous system.
To combat cerebral edema in complex treatment craniocerebral hypothermia is used. However, the question of the advisability of using the latter in each individual case is decided individually.
In cases of SDR caused by infectious pathology, in addition to measures aimed at eliminating gas exchange disorders, antibacterial therapy, combating toxicosis, and increasing the child’s immunological reactivity are indicated. If there is no suspicion of infection, antibiotics are not prescribed during the first 3 days of life. In case of unfavorable course of SDR, deterioration of the child’s condition, infection in complex therapy antibacterial drugs must be included.
Antibiotics have the greatest effect wide range actions: semisynthetic penicillins, cephalosporins, aminoglycosides.
In severe cases, two antibiotics are usually prescribed. The use of ampicillin with oxacillin, methicillin, gentamicin, and carbenicillin is highly effective. The most pronounced antibacterial effect has a combination of ceporin (50 mg/kg) with gentamicin (1.5-2.2 mg/kg).
In the background antibacterial therapy purpose shown antihistamines, vitamins, enzymes, agents that normalize intestinal flora.
With the staphylococcal nature of the disease good effect give hyperimmune antistaphylococcal γ-globulin, hyperimmune antistaphylococcal plasma, direct blood transfusions (8-10 ml/kg with an interval of 2-3 days). Hyperimmune antistaphylococcal plasma is administered intravenously at a rate of 8-10 ml/kg 2-3 times with an interval of 1-3 days.
In case of shock or severe toxicosis, the prescription of hormonal drugs with antitoxic, anti-inflammatory and hyposensitizing effects is indicated. Prednisolone (1-2 mg/kg) or hydrocortisone (5-10 mg/kg) is administered after 6 hours ( daily dose distributed into 4 doses) during the first 2-3 days, followed by a dose reduction and switching to twice-daily administration for up to 5-7 days. Treatment hormonal drugs carried out under the protection of antibiotics, vitamins and potassium preparations.
When symptoms of acute heart failure appear, cardiac glycosides are prescribed.
On the 5-7th day of life, newborns who have undergone SDR are sent to intensive care units organized at children's hospitals.
Transportation of sick newborns must be carried out in special sanitary vehicles equipped with portable incubators. The machines are operated in compliance with the necessary sanitary and epidemiological requirements.
Respiratory distress syndrome (RDS, hyaline membrane disease, respiratory distress syndrome) is a progressive collapse of the alveoli due to surfactant deficiency. The syndrome is characterized by the presence of signs of respiratory distress in the newborn (tachypnea - respiratory rate over 60 per minute, retraction of compliant areas chest and cyanosis when breathing room air), persisting or progressing in the first 48 to 96 hours of life, as well as characteristic changes on a radiograph (diffuse reticulogranular network).
Causes of neonatal respiratory distress syndrome
The basis of neonatal respiratory distress syndrome is surfactant deficiency. Surfactant is a surfactant consisting primarily of phospholipids (75%) and proteins (10%). Surfactant is synthesized by epithelial cells of the lungs (type II pneumocytes) and prevents the collapse of alveoli during exhalation. Surfactant begins to be synthesized from 20 to 24 weeks intrauterine development; The surfactant system fully matures by the 35th - 36th week of gestation.
With a lack of surfactant, the alveoli collapse with each exhalation, which leads to progressive atelectasis of the lungs. Protein exudate and epithelial detritus accumulate in respiratory tract, reducing overall lung capacity. When stained histologically, this material takes on the characteristic appearance of eosinophilic hyaline membranes.
Signs of neonatal respiratory distress syndrome
The disease develops in premature babies or children born with asphyxia. The disease manifests itself as slight respiratory distress at birth, which progressively increases. The newborn develops shortness of breath (in severe cases, 1-2 hours after birth), “grunting exhalation” due to compensatory spasm of the glottis (helps to increase the functional residual capacity), retraction of the intercostal spaces, xiphoid process of the sternum, tension of the wings of the nose, cyanosis, seizures apnea. On auscultation, breathing is sharply weakened, and later dry and intermittent moist fine bubbling and crepitating rales are heard. Hypoxemia, hypercapnia, acidosis, hypovolemia develop early, pulmonary hypertension, microcirculation disorders, heart failure, predominantly right ventricular. As SDR progresses, signs of disseminated intravascular coagulation and shock appear.
The syndrome of respiratory distress can be complicated by hemorrhages in the lungs and ventricles of the brain, pulmonary edema, necrotizing enterocolitis, renal failure. Pneumonia often develops against the background of respiratory distress syndrome.
Diagnosis of neonatal respiratory distress syndrome
In diagnostics various forms respiratory distress syndrome is crucial X-ray examination. With diffuse atelectasis, areas of decreased pneumatization various sizes, alternating with swelling lung tissue, create a mosaic picture. On radiographs, reticular nodose reticulum is initially detected, which is a combination of compactions of the interstitial tissue, small atelectasis and air-stretched alveolar ducts and bronchioles. In the next phase, associated with obstruction of the bronchioles and alveolar ducts, “air bronchograms” (bronchial branches dilated by air) are detected. The third phase is “white lungs” (massive atelectasis, saturated with edematous hemorrhagic fluid, giving the lung fields a pale gray appearance with poorly distinguishable contours of the mediastinum and diaphragm).
Treatment of neonatal respiratory distress syndrome
Treatment is primarily aimed at preventing cooling, since during hypothermia the synthesis of surfactant decreases or even stops (at body temperature below 35 ° C).
It is necessary to maintain airway patency. Oxygen therapy using humidified heated oxygen should be carried out in an incubator or using tents, masks, and nasal catheters. When treating mild and moderate forms of SDR, the method of maintaining constant positive pressure in the airways is used [spontaneous breathing with constant positive pressure(SDPPD)]. The action of SDPPD is associated with the straightening of hypoventilated alveoli and improvement of ventilation-perfusion ratios, which significantly reduces hypoxemia. In severe cases, with repeated attacks of apnea, accompanied by increased cyanosis and hemodynamic disturbances, and if it is impossible to achieve normalization of p a 0 2 in the blood with the help of CPAP, mechanical ventilation is indicated.
Treatments for neonatal respiratory distress syndrome
Infusion therapy(5-10% solutions of glucose, sodium chloride, potassium, calcium preparations) are carried out with caution, since excess fluid volume contributes to the opening of fetal shunts and the development of pulmonary edema. When the hematocrit decreases below 0.4 in the first days of life, a transfusion of red blood cells is performed; in case of hypovolemia, fresh frozen plasma and albumin are given.
Nutrition of a newborn in severe forms of the disease is usually parenteral, with a fairly rapid transition to enteral, since parenteral nutrition inhibits the maturation of the gastrointestinal tract, promotes atrophy of the intestinal mucosa, cholestasis, dysfunction of the liver and pancreas. After stabilization of the child’s condition, the native drug is administered 24 hours a day through a gastric tube. mother's milk. If the condition improves, shortness of breath decreases (respiratory rate up to 60 per minute), and there is no apnea, dosed feeding is prescribed after 3 hours.
Newborns with respiratory distress syndrome are at high risk of developing infectious complications Therefore, antibiotics are included in the treatment complex.
Very premature infants are treated with surfactant preparations. Surfactant is instilled through an endotracheal tube into the trachea and lungs. Most effective prophylactic administration surfactant in the first minutes of a child’s life (no later than 6-8 hours).
