What is Respiratory Distress Syndrome (RDS)

Respiratory distress syndrome is a common lung problem in babies who are born early (prematurely). It causes newborns to have difficulty breathing, along with bluish discoloration of the skin (cyanosis) due to the inability to get enough oxygen.

RDS can be serious and dangerous for a newborn. A baby with this condition must be monitored or treated right away.

RDS can happen when there is a lack of a liquid inside the lungs called surfactant. Surfactant helps keep air sacs in the lungs (alveoli) from collapsing after a baby exhales. When there is not enough surfactant, the alveoli cannot take in oxygen or get rid of waste gas (carbon dioxide) the way they should. Surfactant is produced close to the end of pregnancy, which is why premature babies often develop RDS. Other situations can cause surfactant to be ineffective, which puts term newborns at risk as well.

What are the causes?

This condition may be caused by:

• Immature or underdeveloped lungs.
• Fluid in the lungs.
• Infection.
• Inhaling blood, amniotic fluid, or stool at the time of birth (aspiration).
• Blood problems.
• Diabetes in the mother.
• C-section (cesarean) delivery.
• Lack of oxygen during labor (birth asphyxia).
• Low body temperature (hypothermia).
• Heart or lung birth defects.

What are the signs or symptoms?

Symptoms of this condition include:

• Fast breathing (tachypnea).
• Difficulty breathing.
• The chest or the areas between the ribs pulling inward (retracting) with each breath.
• Widening (flaring) nostrils.
• Grunting sounds.
• Cyanosis around the lips or throughout the body.
• Long pauses in breathing (apnea).

Breathing problems usually begin within minutes or hours after birth.

How is this diagnosed?

RDS in newborns is often first recognized by observing that the baby is struggling to breathe. Your baby may have tests to help diagnose RDS, such as:

• Chest X-ray.
• Placing a probe on the hand or foot to determine blood oxygen level (pulse oximetry).
• Blood tests (blood gas).
• Echocardiogram.

Additional tests may be needed to rule out other causes of RDS.

How is this treated?

This condition is treated at the hospital. Treatment depends on the severity of the condition, and may include:

• Placing a tube that delivers oxygen (blow-by or nasal cannula) near or in your baby’s nostrils.
• Using a device to deliver a small amount of pressure into your baby’s lungs to help keep them open (continuous positive airway pressure, CPAP).
• Putting surfactant into your baby’s lungs. This requires placement of a tube that goes into your baby’s mouth or nose, and down to the lungs (intubation).
• Having your baby breathe with the help of a breathing machine called a ventilator. This can be done while the lungs grow, heal, or both.
• Having your baby breathe in a gas that helps blood vessels in the lungs work better (inhaled nitric oxide).
• Antibiotic medicines to treat infection.
• Keeping your baby in a very quiet, dark, low-stimulation environment to decrease the amount of oxygen he or she needs.
• Avoiding feeding your baby by mouth while he or she is breathing rapidly. Instead, your baby may receive fluids and nutrition through: 
  • A tube that is placed into the nose or mouth and down into the stomach (nasogastric tube, NG tube).
  • An IV that is inserted into one of your child’s veins.
• Treating any problems caused by RDS, such as acid–base balance, low blood pressure (hypotension), low oxygen levels (hypoxia), or low body temperature (hypothermia).

If your child’s condition was caused by a collapsed lung or heart defect, additional treatments may be needed.

Follow these instructions at home:

Preventing infections and other problems

• Your child may be more likely to get certain illnesses during recovery from RDS. If your child had severe RDS, he or she also has a higher risk of developing asthma as a child. Take these actions to protect your child from illness:
  • Wash your hands thoroughly and often with soap and water. If soap and water are not available, use hand sanitizer.
  • Keep your child away from crowds. This helps prevent your child from being exposed to various viral or bacterial illnesses.
  • Keep your child away from things that irritate the lungs, such as cigarette smoke.
  • Make sure that your child gets all of the appropriate immunizations and attends all well-child visits.

General instructions

• If your baby requires home oxygen therapy, follow instructions from your child’s health care provider about how to provide oxygen therapy.
• Give over-the-counter and prescription medicines only as told by your child’s health care provider.
• Keep all follow-up visits as told by your child’s health care provider. This is important.

How is this prevented?

If a premature delivery is anticipated, certain medicines given to the mother can reduce the risk of RDS. These medicines include:

• Medicines that treat preterm labor (tocolytics).
• A medicine that improves fetal lung development (corticosteroid).
• Antibiotic medicine, if there is a potential infection.

Babies born extremely early (at less than 27 weeks) may benefit from receiving surfactant prior to being diagnosed with RDS.

Get help right away if:

• Your baby is breathing fast or having difficulty breathing.
• Your baby makes grunting sounds while trying to breathe.
• Your baby’s nostrils flare while breathing.
• Your baby uses the muscles of the neck, chest, and ribs while breathing.
• Your baby develops cyanosis around the lips or under the fingernails.
• Your baby makes loud noises when breathing (wheezes).
• Your baby develops apnea.

Summary

• Respiratory distress syndrome (RDS) is a common lung problem in babies who are born early (prematurely). It causes newborns to have difficulty breathing, along with bluish discoloration of the skin (cyanosis).
• RDS can happen when there is a lack of a liquid inside the lungs called surfactant. Surfactant is produced close to the end of pregnancy, which is why premature babies often develop RDS. Other situations can cause surfactant to be ineffective, which puts term newborns at risk as well.
• This condition is treated at the hospital. Treatment depends on the severity of the condition and may include oxygen therapy.
• Get help right away if you notice changes in your baby’s breathing.