RDS is a type of neonatal respiratory disease that is caused most often by a lack of surfactant in the lungs. A fetus's lungs start making surfactant during the third trimester of pregnancy, or weeks 26 through labor and delivery. Surfactant coats the insides of the air sacs, or alveoli, in the lungs. This helps keep the lungs open so breathing can occur after birth. To understand respiratory distress syndrome, it helps to learn about how the lungs work.
Without enough surfactant, the lungs may collapse when the newborn exhales. The newborn then has to work harder to breathe. He or she might not be able to get enough oxygen to support the body's organs.
Certain factors may increase the risk that your newborn will have RDS. These factors include:
Your baby also is at greater risk for RDS if you require an emergency cesarean delivery before your baby is full term. You may need an emergency cesarean delivery because of a condition, such as a detached placenta, that puts you or your newborn at risk.
Planned cesarean deliveries that occur before a baby's lungs have fully matured can also increase your baby’s risk for RDS. Your doctor can do tests before delivery that show whether it is likely that your baby's lungs are fully developed. These tests determine the age of the fetus or lung maturity.
Taking steps to ensure a healthy pregnancy might prevent your newborn from being born before his or her lungs have fully developed. These steps include:
Your doctor may give you injections of a corticosteroid medicine if he or she thinks you may give birth too early. This medicine can speed up development of the lungs, brain, and kidneys in your baby and surfactant production. Usually, within about 24 hours of your taking this medicine, the baby's lungs start making enough surfactant.
Treatment with corticosteroids can reduce your baby's risk for RDS. If the baby does develop RDS, it may not be as serious.
Signs and symptoms of RDS include:
The newborn also may have pauses in breathing that last for a few seconds. This condition is called apnea.
Many babies who are born with RDS develop bronchopulmonary dysplasia (BPD). If babies born with RDS still require oxygen therapy by the time they reach their original due dates, they are diagnosed with BPD.
Depending on the severity of a newborn's RDS, he or she may develop other medical problems.
RDS is common in premature newborns. Thus, doctors usually recognize and begin treating the disorder as soon as babies are born.
Doctors also do several tests to rule out other conditions that could be causing a newborn's breathing problems. The tests also can confirm that the doctors have diagnosed the condition correctly.
The tests include:
Treatment for RDS usually begins as soon as a newborn is born, sometimes in the delivery room. Treatments for RDS include surfactant replacement therapy, breathing support from a ventilator or nasal continuous positive airway pressure (NCPAP) machine, or other supportive treatments.
Most newborns who show signs of RDS are quickly moved to a neonatal intensive care unit (NICU). There they receive around-the-clock treatment from healthcare professionals who specialize in treating premature newborns.
Surfactant helps keep the lungs open so that a newborn can breathe in air once he or she is born. Babies who have RDS get surfactant until their lungs are able to start making the substance on their own. Surfactant is usually given through a breathing tube. The tube allows the surfactant to go directly into the baby's lungs.
Once the surfactant is given, the breathing tube is connected to a ventilator, or the baby may get breathing support from NCPAP.
Surfactant often is given right after birth in the delivery room to try to prevent or treat RDS. It also may be given several times in the days that follow, until the baby is able to breathe better.
Some women are given medicines called corticosteroids during pregnancy. These medicines can speed up surfactant production and lung development in a fetus. Even if you had these medicines, your newborn may still need surfactant replacement therapy after birth.
Newborns who have RDS often need breathing support, or oxygen therapy, until their lungs start making enough surfactant. Until recently, a mechanical ventilator usually was used. The ventilator was connected to a breathing tube that ran through the newborn's mouth or nose into the windpipe.
Today, more and more newborns are receiving breathing support from NCPAP. NCPAP gently pushes air into the baby's lungs through prongs placed in the newborn's nostrils.
Treatment in the NICU helps limit stress on babies and meet their basic needs of warmth, nutrition, and protection. Such treatment may include:
After your baby leaves the hospital, he or she will likely need follow-up care. It is important to follow your child’s treatment plan and get regular care. It is also important to take care of your mental health as you care for your baby at home.
Your baby may need special care after leaving the NICU, including:
Talk to your child's doctor about ongoing care for your newborn and any other medical concerns you have.
Newborns who have RDS may have health problems even after they leave the hospital. These include:
The risk of these complications increases in newborns who are very small at birth.
You can take steps to help manage your child's RDS and help him or her recover.
Caring for a premature newborn can be challenging. You may experience:
You can take steps to help yourself during this difficult time.
Learn about the following ways the NHLBI continues to translate current research into improved health for newborns who have respiratory distress syndrome. Research on this topic is part of the NHLBI’s broader commitment to advancing lung disease scientific discovery.
In support of our mission, we are committed to advancing respiratory distress syndrome research, in part through the following ways.
Learn about exciting research areas the NHLBI is exploring about respiratory distress syndrome.
We lead or sponsor many studies related to respiratory distress syndrome. See if you or someone you know is eligible to participate in our clinical trials.
After reading our Respiratory Distress Syndrome Health Topic, you may be interested in additional information found in the following resources.