Hyaline membrane disease (HMD); Infant respiratory distress syndrome; Respiratory distress syndrome in infants; RDS - infants
Neonatal respiratory distress syndrome (RDS) is a problem often seen in premature babies. The condition makes it hard for the baby to breathe.
Neonatal RDS occurs in infants whose lungs have not yet fully developed.
The disease is mainly caused by a lack of a slippery substance in the lungs called surfactant. This substance helps the lungs fill with air and keeps the air sacs from deflating. Surfactant is present when the lungs are fully developed.
Neonatal RDS can also be due to genetic problems with lung development.
Most cases of RDS occur in babies born before 37 to 39 weeks. The more premature the baby is, the higher the chance of RDS after birth. The problem is uncommon in babies born full-term (after 39 weeks).
Other factors that can increase the risk for RDS include:
Most of the time, symptoms appear within minutes of birth. However, they may not be seen for several hours. Symptoms may include:
The following tests are used to detect the condition:
Babies who are premature or have other conditions that make them at high risk for the problem need to be treated at birth by a medical team that specializes in newborn breathing problems.
Infants will be given warm, moist oxygen. However, this treatment needs to be monitored carefully to avoid side effects from too much oxygen.
Giving extra surfactant to a sick infant has been shown to be helpful. However, the surfactant is delivered directly into the baby's airway, so some risk is involved. More research still needs to be done on which babies should get this treatment and how much to use.
Assisted ventilation with a ventilator (breathing machine) can be lifesaving for some babies. However, use of a breathing machine can damage the lung tissue, so this treatment should be avoided if possible. Babies may need this treatment if they have:
A treatment called continuous positive airway pressure (CPAP) may prevent the need for assisted ventilation or surfactant in many babies. CPAP sends air into the nose to help keep the airways open. It can be given by a ventilator (while the baby is breathing independently) or with a separate CPAP device.
Babies with RDS need close care. This includes:
The condition often gets worse for 2 to 4 days after birth and improves slowly after that. Some infants with severe respiratory distress syndrome will die. This most often occurs between days 2 and 7.
Long-term complications may develop due to:
Air or gas may build up in:
Other conditions associated with RDS or extreme prematurity may include:
Most of the time, this problem develops shortly after birth while the baby is still in the hospital. If you have given birth at home or outside a medical center, get emergency help if your baby has breathing problems.
Taking steps to prevent premature birth can help prevent neonatal RDS. Good prenatal care and regular checkups beginning as soon as a woman discovers she is pregnant can help avoid premature birth.
The risk of RDS can also be lessened by the proper timing of delivery. An induced delivery or cesarean may be needed. A lab test can be done before delivery to check the readiness of the baby's lungs. Unless medically necessary, induced or cesarean deliveries should be delayed until at least 39 weeks or until tests show that the baby's lungs have matured.
Medicines called corticosteroids can help speed up lung development before a baby is born. They are often given to pregnant women between 24 and 34 weeks of pregnancy who seem likely to deliver in the next week. More research is needed to determine if corticosteroids may also benefit babies who are younger than 24 or older than 34 weeks.
At times, it may be possible to give other medicines to delay labor and delivery until the steroid medicine has time to work. This treatment may reduce the severity of RDS. It may also help prevent other complications of prematurity. However, it will not totally remove the risks.
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Kliegman RM, St. Geme JW, Blum NJ, Shah SS, Tasker RC, Wilson KM. Diffuse lung diseases in childhood. In: Kliegman RM, St. Geme JW, Blum NJ, Shah SS, Tasker RC, Wilson KM, eds. Nelson Textbook of Pediatrics. 21st ed. Philadelphia, PA: Elsevier; 2020:chap 434.
Lagoski M, Hamvas A, Wambach JA. Respiratory distress syndrome in the neonate. In: Martin RJ, Fanaroff AA, Walsh MC, eds. Fanaroff and Martin's Neonatal-Perinatal Medicine. 11th ed. Philadelphia, PA: Elsevier; 2020:chap 64.
Rozance PJ, Wright CJ. The neonate. In: Landon MB, Galan HL, Jauniaux ERM, et al, eds. Gabbe's Obstetrics: Normal and Problem Pregnancies. 8th ed. Philadelphia, PA: Elsevier; 2021:chap 23.BACK TO TOP
Review Date: 4/14/2021
Reviewed By: Charles I. Schwartz, MD, FAAP, Clinical Assistant Professor of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, General Pediatrician at PennCare for Kids, Phoenixville, PA. Also reviewed by David Zieve, MD, MHA, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.
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