Since 1984 we have cared for 11 neonates with severe respiratory distress whose clinical characteristics appear distinctive: 1) full-term by obstetric and Dubowitz criteria (median 39 wks, range 37-42; median BW 2950g, range 2610-4360), 2) diffuse alveolar disease radiographically, 3) requiring FiO2 1.0 and mechanical ventilation to maintain paO2 50, 4) absence of other conditions known to produce a similar clinical profile. No mothers were diabetic or Rh-sensitized. Blood cultures and latex agglutination bacterial antigen studies were negative in all. None had aspirated meconium. Two-dimensional echocardiography and simultaneous pre- and postductal ABGs showed no evidence of cyanotic congenital heart disease or extrapulmonary right-to-left mix. Among the 11, 5 had 5 minute Apgar scores ≤5, 8 had evidence of fetal distress, 5 had initial hematocirts <45, and 7 had hypotension or oliguria requiring pressors and/or volume support. Seven had multiple organ dysfunction. AH 11 survived but required prolonged mechanical ventilation and supplemental oxygen. Trials of hyperventilation (pH ≥7.55, paCO2 ≤25) in 8 and tolazoline in 4 failed to increase paO2 by >20 torr. Among 7 infants who underwent trials of increased PEEP to ≥6 cm H2O (range 6-10) without other concurrent changes in ventilator settings, 6 responded with prompt increases in paO2 >20 torr (median 68, range 22-136), despite resultant mean airway pressure (PAW) being lower than previously unsuccessful PAWs in 4 of 6. We suggest that ARDS is a distinctive clinical entity in neonates. A trial of PEEP ≥6 cm H2O should be considered in full-term infants with severe respiratory distress in whom other causes can be excluded.
About this article
Cite this article
Faix, R., Viscardi, R., Dipietro, M. et al. ADULT RESPIRATORY DISTRESS SYNDROME (ARDS) IN NEONATES: A CLINICAL SYNDROME. Pediatr Res 21, 199 (1987). https://doi.org/10.1203/00006450-198704010-00200