What are the potential complications of RDS that I should monitor for in the management of these infants?

When managing infants with respiratory distress syndrome (RDS), it is important to monitor for potential complications, both long-term and acute.

• Bronchopulmonary Dysplasia (BPD): A significant long-term complication to monitor for is bronchopulmonary dysplasia (BPD), a chronic lung disease ¹. Risk factors for BPD include lower gestational age, lower birthweight, invasive ventilation begun within 24 hours of birth, clinical sepsis, and treatment with surfactant or for a patent ductus arteriosus (PDA), which often reflect the severity of the baby's condition ¹. Dexamethasone may be considered to reduce the risk of BPD in preterm babies who are 8 days or older and still require invasive ventilation ¹.
• Acute Respiratory Deterioration and Failure: Monitor closely for signs of worsening respiratory distress or impending respiratory failure ². These include:
  • Severe Respiratory Distress: Look for grunting, marked chest recession, nasal flaring, or a respiratory rate over 60 breaths/minute ²,³. Moderate or severe chest indrawing is also a sign ³.
  • Hypoxia: Signs of hypoxia can include agitation, behavioural changes, cyanosis (bluish lips or extremities), or pallor ²,³. Persistent oxygen saturation of less than 92% when breathing air is a concern ².
  • Impending Respiratory Failure: Be aware of listlessness, decreased respiratory effort, recurrent apnoea, or failure to maintain adequate oxygen saturation despite oxygen supplementation ².
  • Altered Consciousness and Activity: The infant may appear seriously unwell, not wake, or if roused, not stay awake, or show decreased activity and no response to social cues ²,³.
  • Feeding Difficulties: Difficulty with breastfeeding or inadequate oral fluid intake (50–75% of usual volume) can indicate deterioration ².
• Patent Ductus Arteriosus (PDA): A PDA can become a significant clinical problem, for example, causing difficulty weaning the baby from a ventilator, and should be monitored in this context ¹.
• Physiological Parameters: Continuous pulse oximetry should be used to measure oxygen saturation, aiming for 91% to 95% after initial stabilisation ¹. For preterm babies on invasive ventilation, carbon dioxide partial pressure (PCO2) should be monitored, aiming for specific ranges ¹. Blood pressure should also be monitored, especially if dexamethasone is used, due to the risk of hypertension ¹.