Minimizing the risk of respiratory distress syndrome

Respiratory distress syndrome, or hyaline membrane disease, remains one of the most significant causes of neonatal morbidity and mortality, despite advances in perinatal care. It is a condition predominantly affecting premature infants, with an incidence inversely related to gestational age. Whilst many infants will improve within a few days, more severely affected babies are at risk of developing chronic lung disease, and a range of extrapulmonary complications. Minimizing the risk of respiratory distress syndrome requires a combination of preventative strategies prior to and in the immediate aftermath of delivery and a balanced approach to treatment of established disease. The use of antenatal steroids and pulmonary surfactant have revolutionized perinatal medicine, however a number of controversies still exist for both treatments such as optimal dosing, timing, and repeat courses. This article reviews the current evidence for these treatments, as well as over viewing the other essential antenatal and perinatal concerns faced when managing an infant at risk of respiratory distress syndrome.