The therapeutic challenges of respiratory distress syndrome in the newborn – case report

Abstract

Severe respiratory insufficiency is commonly observed in newborns with severe perinatal asphyxia. It represents the result of underlying or subsequent disorders such as me­co­nium aspiration syndrome, sepsis or pneumonia. Case report. We present the case of a newborn resulted from a pregnancy without prenatal care. The pregnant wo­man was admitted in advanced labor and she delivered va­gi­nally, 10 minutes later after the hospitalization. The ini­tial clinical examination of the newborn revealed a male of 3780 g, IA 1/3/5, with severe asphyxia, who required ex­ten­sive resuscitation at birth in the delivery room. The evo­lu­tion was towards the deterioration of the general con­di­tion during the first days of life, with hepatic and re­nal in­suf­fi­cien­cy and metabolic disorders (hypoglycemia, hy­po­cal­­ce­mia). The cardiac ultrasound did not detect chan­ges in parietal kinetics, valvulopathies or other flow-pressure di­sorders capable of determining those cli­ni­cal symptoms. The neurologic examination revealed clonic movements of the upper and lower limbs, decreased mus­cu­lar tonus and re­flexes in the first days of life, but lat­er the tonus gradually im­proved. The transfontanelar ul­tra­sound showed the “flu” as­pect of the brain substance, fi­li­form lateral ventricles lo­ca­ted symmetrically to the midline and low Doppler flow. The evolution was fa­vou­rable with intensive care treat­ment and the baby was dis­charged after 21 days. The infant had a good ge­ne­ral condition, with no fever and with normal cardiac, res­pi­ra­tory, renal and hepatic func­tions. Conclusions. Res­pi­ra­tory distress syndrome (RDS) represents a challenge for neonatologists because it may have different causes that determine the treatment and follow-up of the new­born. When RDS is associated with multiple organs in­ju­ries, prolonged neonatal intensive care is required.