Respiratory Distress Syndrome in Preterm Neonates: A Comprehensive Narrative Review

Background: Respiratory distress syndrome (RDS) is a leading cause of respiratory morbidity and mortality in preterm neonates, primarily resulting from surfactant deficiency and structural lung immaturity. Despite advances in perinatal care, RDS continues to contribute to substantial early neonatal mortality and long-term complications such as bronchopulmonary dysplasia (BPD), especially in extremely preterm infants. Materials and Methods: A narrative review of published literature was conducted using standard neonatology textbooks, international guidelines (European 2022 and Indian 2022), and peer-reviewed articles from PubMed, Cochrane Library, and Google Scholar. The search covered publications from 1959 to 2023. Key references were identified through targeted database searches and manual screening of reference lists from seminal papers. A total of 35 key references were selected based on their scientific rigor, clinical relevance and contribution to understanding fetal lung development, surfactant biology, epidemiology, pathophysiology, diagnostic approaches, and management strategies for RDS in preterm neonates. Results: Advances in antenatal care, respiratory support, and surfactant therapy have significantly improved outcomes in preterm infants with RDS. Improved understanding of lung development and surfactant biology has guided preventive strategies such as antenatal corticosteroids. Diagnostic modalities have evolved from chest radiography to lung ultrasound, which allows reliable bedside assessment and prediction of CPAP failure and surfactant requirement. Management has shifted toward early CPAP, caffeine therapy, volume-targeted ventilation, and minimally invasive surfactant administration techniques such as LISA/MIST, reducing ventilatorinduced lung injury and improving survival without BPD. Conclusion: Integration of modern diagnostic tools, minimally invasive respiratory support, and guideline-based management has transformed outcomes in RDS OF preterm infants. Adapting global recommendations to local resource settings is essential for further improving survival and long-term respiratory outcomes.