Neonatal Respiratory Distress Syndrome (RDS) / Hyaline Membrane Disease

Classic features in a preterm neonate (34 weeks):

• Grunting (auto-PEEP to prevent alveolar collapse)
• Subcostal/intercostal retractions
• Central cyanosis
• Ground glass appearance + air bronchograms on CXR

Pathophysiology:

\[\downarrow \text{Surfactant} \Rightarrow \uparrow \text{Alveolar surface tension} \Rightarrow \text{Alveolar collapse (atelectasis)} \Rightarrow \text{V/Q mismatch} \Rightarrow \text{Hypoxia}\]

Treatment:

• Surfactant replacement therapy (Poractant alfa / Beractant) via ETT — single or multiple doses
• Respiratory support: nCPAP (preferred if breathing spontaneously) or mechanical ventilation
• Oxygen to maintain SpO₂ \(91{-}95\%\) (avoid hyperoxia — risk of ROP)
• Caffeine citrate (reduces apnea of prematurity)

Prevention (antenatal): Betamethasone \(12\,\text{mg}\) IM × 2 doses (24 hr apart) given to mother before 34 weeks delivery — accelerates fetal surfactant production.