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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 β single or multiple doses
- Respiratory support: nCPAP (preferred if breathing spontaneously) or mechanical ventilation
- Oxygen to maintain SpOβ \(91{-}95\%\) (avoid hyperoxia β risk of ROP)
- Caffeine citrate (reduces apnea of prematurity)
Prevention (antenatal): Betamethasone \(12\,\text{mg}\) IM Γ 2 doses (24 hr apart) given to mother before 34 weeks delivery β accelerates fetal surfactant production.
For a levered firm (a firm that uses debt financing), which of the following ratios would ideally indicate the highest return to equity shareholders?
A levered firm uses debt, which creates a financial leverage effect. When a firm earns more on borrowed funds than it pays in interest, the surplus accrues to equity shareholders β amplifying returns. Return on Common Equity (ROE) $= \dfrac{\text{Net Income}}{\text{Shareholders' Equity}}$ captures this magnified return because the denominator (equity) is smaller when the firm uses debt. ROA and ROCE use total assets or capital employed (including debt) as the base, which dilutes the leverage effect.
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