Review article

Abstract

Most lifelong neurologic damage originales during the perinatal period. The major cause is asphyxia that almost always is preventable. Among diseases causing neonatal asphyxia, the respiratory distress syndrome (RDS) resulted in 10-15% of perinatal and 20-35% of neonatal deaths [129, 150]. The incidence of neurological handicaps in children surviving severe RDS was many times higher than in the normal population. The prime factor predisposing to perinatal mortality äs well äs RDS is prematurity. More than 90% of fatal cases of RDS were less than 35 weeks gestation, whereas term infants get RDS only occasionally. The estimated overall incidence of RDS in infants weighing less than 2500 gm is about 14% [48]. Perinatal asphyxia and asphyxia at birth are other significant factors increasing the incidence and severity of RDS [15,38,96,159]. Elective cesarean section when performed without proper assessment of the functional maturity of the fetus offers a significant risk for RDS [15,27,55,92,146,181,194]. Finally, the influence of maternal disorders to fetal well being is being appreciated increasingly.Diabetes A and B, particularly when poorly controlled, delays the functional maturity of the lungs [68,158]. RDS hasa characteristic course "beginning" within hours of birth and Clearing within one to two weeks unless fatal or there is chronic lung disease. It can be distinguished from other respiratory disorders such äs meconium aspiration syndrome, infection, congenital anomalies and type II RDS by its typical history and course, characteristic x-ray fmdings, and blood gas analyses indicating shunting of blood from the venous to the arterial System without oxygenation. During the last several years new approaches to therapy such äs intensive care nurseries, regionalization of perinatal care, fetal monitoring and specific treatments, including continuous positive pressure distension of the airways [80] and mechanical Ventilation [51,155] have improved the prognosis both for mortality and neurological sequelae.