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The respiratory distress syndrome (RDS) in preterm infants

Physiology, prophylaxis and new therapeutic approaches

Physiologie, Prophylaxe und neue therapeutische Ansätze des Atemnotsyndroms von Frühgeborenen

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Intensivmedizin und Notfallmedizin

Zusammenfassung

Das Atemnotsyndrom ist eine lebensbedrohliche Erkrankung von Frühgeborenen. Am Anfang des klinischen Bildes steht die Unreife der Lunge, insbesondere der Mangel an Surfactant nach Frühgeburt. Der Surfactantmangel initiiert einen Kreislauf mit Lungeninsuffizienz, Lungenverletzung und weiterer Surfactantinaktivierung durch Blut oder Wundsekret. Die Prävention des Atemnotsyndroms ist durch die Induktion einer fetalen Lungenreifung durch Therapie der Mutter mit Glukokortikoiden möglich, die innerhalb von 48 h eine Lungereifung bewirken. Nach der Geburt ist die Beseitigung des Surfactantmangels durch Surfactant Therapie möglich oder eine Therapie mit continuous positive airway pressure (CPAP). Neue Therapieansätze der Surfactantbehandlung versuchen die bisher notwendige Intubation des frühgeborenen Kindes zu vermeiden. Neue, bisher experimentelle Surfactantpräparationen sind besser gegen Inaktivierung durch Serumproteine oder Mekonium geschützt.

Abstract

The respiratory distress syndrome (RDS) is a life threatening complication of preterm birth. RDS is mainly caused by the immaturity of the preterm lung with respect to surfactant. The surfactant deficiency induces a cascade that results in lung failure and further surfactant inactivation by proteinaceous exsudates from the injured lung. Therapeutic options are the prevention of surfactant deficiency by antepartal administration of maternal corticosteroid therapy inducing lung maturation in the fetus, surfactant replacement therapy in the preterm infant as early as reasonably possible or ventilatory support with continuous positive airway pressure (CPAP). New therapeutic approaches in surfactant therapy aim at preventing the endotracheal intubation. New experimental surfactant preparations will be more resistant to inactivation by proteins or meconium.

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Authors and Affiliations

  1. Department of Pediatrics, Academisch Ziekenhuis Maastricht, 5800, 6202 AZ, Maastricht, The Netherlands

    Boris W. Kramer

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  1. Boris W. Kramer
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Correspondence to Boris W. Kramer.

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Respiratorisches Versagen im Früh- und Neugeborenenalter

Herausgegeben von L. Gortner (Homburg/Saar)

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Kramer, B.W. The respiratory distress syndrome (RDS) in preterm infants. Intensivmed 44, 403–408 (2007). https://doi.org/10.1007/s00390-007-0809-3

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  • DOI: https://doi.org/10.1007/s00390-007-0809-3

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