Which of the following are associated with an increased risk of developing RDS?
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Respiratory distress syndrome (RDS) occurs in babies born early (premature) whose lungs are not fully developed. The earlier the infant is born, the more likely it is for them to have RDS and need extra oxygen and help breathing. Show
RDS is caused by the baby not having enough surfactant in the lungs. Surfactant is a liquid made in the lungs at about 26 weeks of pregnancy. As the fetus grows, the lungs make more surfactant. Surfactant coats the tiny air sacs in the lungs and to help keep them from collapsing (Picture 1). The air sacs must be open to allow oxygen to enter the blood from the lungs and carbon dioxide to be released from the blood into the lungs. While RDS is most common in babies born early, other newborns can get it. Those at greater risk are:
Signs and SymptomsBabies who have RDS may show these signs:
DiagnosisThe diagnosis is made after examining the baby and seeing the results of chest X-rays and blood tests. TreatmentOxygen - Babies with RDS need extra oxygen. It may be given several ways:
Surfactant - Surfactant can be given into the baby’s lungs to replace what they do not have. This is given directly down the breathing tube that was placed in the windpipe. Intravenous (IV) catheter treatments - A very small tube called a catheter, is placed into one or two of the blood vessels in the umbilical cord. This is how the infant gets IV fluids, nutrition and medicines. It is also used to take blood samples. Medicines - Sometimes antibiotics are given if an infection is suspected. Calming medicines may be given to help ease pain during treatment. Warning
What to ExpectThe road to recovery is different for each infant. Often RDS gets worse before it gets better. Some babies need more oxygen than others. Some may require a treatment of surfactant. As the baby is able to breathe better, they may need less oxygen and other help to breathe. Neonatal respiratory distress syndrome To use the sharing features on this page, please enable JavaScript.Neonatal respiratory distress syndrome (RDS) is a problem often seen in premature babies. The condition makes it hard for the baby to breathe. CausesNeonatal 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:
SymptomsMost of the time, symptoms appear within minutes of birth. However, they may not be seen for several hours. Symptoms may include:
Exams and TestsThe following tests are used to detect the condition:
TreatmentBabies 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:
Outlook (Prognosis)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:
Possible ComplicationsAir or gas may build up in:
Other conditions associated with RDS or extreme prematurity may include:
When to Contact a Medical ProfessionalMost 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. PreventionTaking 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. Alternative NamesHyaline membrane disease (HMD); Infant respiratory distress syndrome; Respiratory distress syndrome in infants; RDS - infants ReferencesKamath-Rayne BD, Jobe AH. Fetal lung development and surfactant. In: Resnik R, Lockwood CJ, Moore TR, Greene MF, Copel JA, Silver RM, eds. Creasy and Resnik's Maternal-Fetal Medicine: Principles and Practice. 8th ed. Philadelphia, PA: Elsevier; 2019:chap 16. 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. Review Date 4/14/2021Updated 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. What are the risk factors for RDS?Other factors that can increase the risk for RDS include:. A brother or sister who had RDS.. Diabetes in the mother.. Cesarean delivery or induction of labor before the baby is full-term.. Problems with delivery that reduce blood flow to the baby.. Multiple pregnancy (twins or more). Rapid labor.. Which of the following factors is associated with an increase in the incidence of RDS?The greatest risk factor for respiratory distress syndrome is prematurity, although the syndrome does not occur in all premature newborns. Other risk factors include maternal diabetes, cesarean delivery, and asphyxia.
Which is the major cause of RDS?What causes RDS? RDS is caused by a lack of surfactant in the lungs. The lungs of a fetus start making surfactant during the third trimester, which starts after the 26th week of pregnancy. Surfactant is a foamy substance that keeps the lungs fully expanded so that newborns can breathe in air once they are born.
What are 4 most common cause of respiratory distress?The most common cause of ARDS is sepsis, a serious and widespread infection of the bloodstream. Inhalation of harmful substances. Breathing high concentrations of smoke or chemical fumes can result in ARDS , as can inhaling (aspirating) vomit or near-drowning episodes. Severe pneumonia.
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