Respiratory Distress Syndrome (Newborn)
A breathing disorder of premature newborns from lack of lung surfactant
Quick Facts
- Type: Newborn lung condition
- Main cause: Surfactant deficiency in immature lungs
- Who is affected: Mostly premature babies
- Key treatment: Breathing support and surfactant
Overview
Respiratory distress syndrome (RDS) is a common breathing problem in newborn babies, especially those born prematurely. It is caused by a shortage of surfactant, a soapy substance made in the lungs that coats the tiny air sacs (alveoli) and keeps them from collapsing each time the baby breathes out. Without enough surfactant, the air sacs collapse, making each breath much harder and reducing the oxygen that reaches the body.
This form of RDS is a condition of newborns and is different from acute respiratory distress syndrome (ARDS) seen in older children and adults. The earlier a baby is born, the more likely RDS is, because surfactant production increases toward the end of pregnancy. With modern newborn intensive care, including breathing support and surfactant treatment, most babies with RDS recover well.
Symptoms
Signs of RDS usually appear within minutes to hours of birth and may worsen over the first day or two. They include:
- Fast, labored breathing
- Grunting sounds with each breath
- Flaring of the nostrils
- Pulling in of the skin between and below the ribs with each breath (retractions)
- A bluish color of the skin or lips from low oxygen
- Pauses in breathing (apnea) in some babies
These are signs that the baby is struggling to breathe and needs prompt medical care.
Causes
RDS is caused by immature lungs that have not yet made enough surfactant.
- Prematurity: The main cause, because surfactant is produced mainly in the later weeks of pregnancy.
- Surfactant deficiency: Without enough surfactant, the air sacs collapse and gas exchange is impaired.
- Other contributing factors: A mother with diabetes, delivery by cesarean section before labor, and certain stresses around birth can increase the risk even in less premature babies.
The result is stiff lungs that are hard to inflate and low oxygen levels.
Risk Factors
- Premature birth, with risk rising the earlier the baby is born
- A sibling who had RDS
- Maternal diabetes
- Delivery by cesarean section without labor
- A multiple pregnancy (twins or more)
- Stressful events around the time of birth, such as low oxygen
Diagnosis
RDS is diagnosed by the newborn care team based on the baby's breathing, history, and tests.
- Clinical assessment: Recognizing the typical signs of breathing difficulty soon after birth, particularly in a premature baby.
- Chest X-ray: Often shows a characteristic hazy, fine pattern in the lungs.
- Blood gas tests: Measure oxygen and carbon dioxide levels to gauge how well the lungs are working.
- Oxygen monitoring: Continuous tracking of oxygen levels.
Treatment
Babies with RDS are cared for in a neonatal intensive care unit (NICU). Treatment supports breathing while the lungs mature.
- Surfactant therapy: Replacement surfactant can be given directly into the lungs to help the air sacs stay open.
- Breathing support: Extra oxygen, continuous positive airway pressure (CPAP), or a ventilator helps the baby breathe until the lungs strengthen.
- Supportive care: Maintaining warmth, fluids, nutrition, and gentle handling, and treating any infection.
An important preventive step is giving the mother steroid medicine before a premature birth when possible, which speeds up the baby's lung development and reduces the severity of RDS.
Prevention
- Good prenatal care to help reduce the chance of premature birth
- Steroid injections for the mother before an anticipated preterm delivery to mature the baby's lungs
- Careful timing of planned deliveries to avoid unnecessary early birth
- Managing maternal conditions such as diabetes during pregnancy
When to Seek Help
RDS develops in newborns who are usually already under hospital care, where the team monitors breathing closely. Any newborn showing fast or labored breathing, grunting, nostril flaring, pulling in of the chest, or a bluish color of the lips or skin needs immediate medical attention. After a baby goes home, seek emergency care right away for breathing difficulty, color changes, pauses in breathing, poor feeding, or unusual sleepiness.
Frequently Asked Questions
What causes respiratory distress syndrome in newborns?
It is caused by a shortage of surfactant, a substance that keeps the lungs' air sacs open. Surfactant is made mainly late in pregnancy, so premature babies are most affected, and their air sacs tend to collapse, making breathing very hard.
How is newborn RDS treated?
Babies are cared for in a neonatal intensive care unit with breathing support such as extra oxygen, CPAP, or a ventilator, and often with replacement surfactant given into the lungs. Supportive care continues until the lungs mature.
Can respiratory distress syndrome be prevented?
Risk can be lowered by good prenatal care and, when a premature birth is expected, by giving the mother steroid injections that speed up the baby's lung development. Avoiding unnecessary early deliveries also helps.
Is newborn RDS the same as ARDS in adults?
No. Newborn RDS is caused by immature lungs lacking surfactant, while acute respiratory distress syndrome (ARDS) in older children and adults is a severe lung injury from other illnesses or injuries. They are different conditions with different causes.
References
- National Heart, Lung, and Blood Institute (NHLBI). Respiratory Distress Syndrome.
- MedlinePlus, U.S. National Library of Medicine. Respiratory distress syndrome in infants.
- American Academy of Pediatrics (AAP). Newborn respiratory distress.