A full-term pregnancy lasts 40 weeks. This gives the fetus time to grow. At 40 weeks, the organs are usually fully developed. If a baby is born too early, the lungs may not be fully developed, and they may not function properly. Healthy lungs are crucial for overall health.
Neonatal respiratory distress syndrome, or neonatal RDS, may occur if the lungs aren’t fully developed. It typically occurs in premature babies. Infants with neonatal RDS have difficulty breathing normally.
Neonatal RDS is also known as hyaline membrane disease and infant respiratory distress syndrome.
Surfactant is a substance that enables the lungs to expand and contract. It also keeps the small air sacs in the lungs, known as alveoli, open. Premature infants lack surfactant. This can cause lung problems and trouble breathing.
RDS may also occur because of a developmental problem linked to genetics.
The lungs and lung function develop in utero. The earlier an infant is born, the higher the risk of RDS. Infants born before 28 weeks gestation are especially at risk. Other risk factors include:
- a sibling with RDS
- multiple pregnancy (twins, triplets)
- impaired blood flow to the baby during delivery
- delivery by cesarean
- maternal diabetes
An infant will typically display signs of RDS shortly after birth. However, sometimes symptoms develop within the first 24 hours after birth. Symptoms to watch for include:
- bluish tint to skin
- flaring of nostrils
- rapid or shallow breathing
- reduced urine output
- grunting while breathing
If a doctor suspects RDS, they’ll order lab tests to rule out infections that could cause breathing problems. They’ll also order a chest X-ray to examine the lungs. A blood gas analysis will check oxygen levels in the blood.
When an infant is born with RDS and symptoms are immediately apparent, the infant is usually admitted to a neonatal intensive care unit (NICU).
The three main treatments for RDS are:
- surfactant replacement therapy
- a ventilator or nasal continuous positive airway pressure (NCPAP) machine
- oxygen therapy
Surfactant replacement therapy gives an infant the surfactant they lack. The therapy delivers the treatment through a breathing tube. This ensures it goes into the lungs. After receiving the surfactant, the doctor will connect the infant to a ventilator. This provides extra breathing support. They may need this procedure several times, depending on the severity of the condition.
The infant may also receive ventilator treatment alone for breathing support. A ventilator involves placing a tube down into the windpipe. The ventilator then breathes for the infant. A less invasive breathing support option is a nasal continuous positive airway pressure (NCPAP) machine. This administers oxygen through the nostrils by a small mask.
Oxygen therapy delivers oxygen to the infant’s organs via the lungs. Without adequate oxygen, the organs don’t function properly. A ventilator or NCPAP can administer oxygen. In the mildest cases, oxygen can be given without a ventilator or nasal CPAP machine.
Preventing premature delivery lowers the risk of neonatal RDS. To reduce the risk of premature delivery, get consistent prenatal care throughout pregnancy and avoid smoking, illicit drugs, and alcohol.
If a premature delivery is likely, the mother may receive corticosteroids. These drugs promote faster lung development and production of surfactant, which is very important to fetal lung function.
Neonatal RDS may get worse over the first few days of a baby’s life. RDS can be fatal. There may also be long-term complications due to either receiving too much oxygen or because organs lacked oxygen. Complications can include:
- air buildup in the sac around the heart, or around the lungs
- intellectual disabilities
- blood clots
- bleeding into the brain or lungs
- bronchopulmonary dysplasia (a breathing disorder)
- collapsed lung (pneumothorax)
- blood infection
- kidney failure (in severe RDS)
Talk with your doctor about the risk of complications. They depend on the severity of your infant’s RDS. Each infant is different. These are simply possible complications; they might not occur at all. Your doctor can also connect you to a support group or counselor. This can help with the emotional stress of dealing with a premature infant.
Neonatal RDS can be a challenging time for parents. Talk to your pediatrician or neonatal doctor for advice on resources to help you manage the next few years of your child’s life. Further testing, including eye and hearing exams and physical or speech therapy, may be necessary in the future. Seek support and encouragement from support groups to help you deal with the emotional stress.