Respiratory distress syndrome (RDS)
is a common problem in premature babies. It causes babies to need extra oxygen and
with breathing. The course of illness with RDS depends on:
- The size and gestational age of your
- How serious the illness is
- Whether your baby has an
- Whether your baby has a heart defect
called patent ductus arteriosus
- Whether your baby needs a machine to
help them breathe (ventilator)
RDS typically gets worse over the
first 2 to 3 days. It then gets better with treatment.
RDS occurs when there is not enough
surfactant in the lungs. Surfactant is a liquid made by the lungs that keeps the airways
(alveoli) open. This liquid makes it possible for babies to breathe in air after
delivery. An unborn baby starts to make surfactant at about 26 weeks of pregnancy.
baby is premature (born before 37 weeks of pregnancy), they may not have made enough
When there is not enough surfactant, the tiny alveoli collapse with each breath. As
the alveoli collapse, damaged cells collect in the airways. They further affect breathing.
The baby has to work harder and harder to breathe trying to reinflate the collapsed
As the baby’s lung function gets worse, the baby takes in less oxygen. More carbon
dioxide builds up in the blood. This can lead to increased acid in the blood (acidosis).
This condition can affect other body organs. Without treatment, the baby becomes exhausted
trying to breathe and over time gives up. A ventilator must do the work of breathing
RDS occurs most often in babies born before the 28th week of pregnancy. Some premature
babies get RDS severe enough to need a breathing machine (ventilator). The more premature
the baby, the higher the risk and the more severe the RDS.
Most babies with RDS are premature.
But other things can raise the risk of getting the disease. These include:
- The baby is a boy or is white
- The baby has a sibling born with RDS
- C-section (Cesarean) delivery,
especially without labor. Going through labor helps babies’ lungs become ready to
- The baby doesn’t get enough oxygen just before, during, or after birth (perinatal
- The baby has trouble maintaining body temperature (cold stress)
- The baby is a twin or other multiple (multiple birth babies are often premature)
- The mother has diabetes (a baby with
too much insulin in their body can delay making surfactant)
- The baby has a condition called patent ductus arteriosus (PDA)
These are the most common symptoms
- Breathing problems at birth that get
- Blue skin color (cyanosis)
- Flaring nostrils
- Rapid breathing
- Grunting sounds with breathing
- Ribs and breastbone pulling in when
the baby breathes (chest retractions)
The symptoms of RDS usually get
worse by the third day. When a baby gets better, they need less oxygen and mechanical
help to breathe.
The symptoms of RDS may look like
other health conditions.
RDS is usually diagnosed by a
combination of these:
appearance, color, and breathing efforts.
These can point to a baby’s
need for help with breathing.
of the lungs.
X-rays make images of bones and organs.
These measure the amount of oxygen, carbon dioxide and acid in
the blood. They may show low oxygen and higher amounts of carbon dioxide.
Echocardiography. This test is a type of ultrasound that looks at the
structure of the heart and how it is working. The test is sometimes used to rule out
heart problems that might cause symptoms similar to RDS. It will also show whether
PDA may be making the problem worse.
Treatment will depend on your child’s symptoms, age, and general health. It will also
depend on how severe the condition is.
Treatment for RDS may include:
- Placing a breathing tube into your baby’s windpipe (trachea)
- Having a ventilator breathe for the baby
- Extra oxygen (supplemental oxygen)
- Continuous positive airway pressure (CPAP). This is a breathing machine that pushes
a continuous flow of air or oxygen to the airways. It helps keep tiny air passages
in the lungs open.
- Artificial surfactant. This helps the most if it is started in the first 6 hours of
birth. Surfactant replacement may help make RDS less serious. It is given as preventive
treatment for some babies at very high risk for RDS. For others who become sick after
birth, it is used as a rescue method. Surfactant is a liquid given through the breathing
- Medicines to help calm the baby and ease pain during treatment
Babies sometimes have complications from RDS treatment. As with any disease, more
severe cases often have greater risks for complications. Some complications of RDS
- Lungs leak air into the chest, the sac around the heart, or elsewhere in the chest
- Chronic lung disease (bronchopulmonary dysplasia)
Preventing a premature birth is the main way to prevent RDS. When a premature birth
can’t be prevented, you may be given corticosteroids before delivery. These medicines
may greatly lower the risk and severity of RDS in the baby. These steroids are often
given between 24 and 34 weeks of pregnancy to women at risk of early delivery. They
may sometimes be given up to 37 weeks. But if the delivery is very quick or unexpected,
there may not be time to give the steroids. Or they may not have a chance to start
- Respiratory distress syndrome (RDS) is a common problem in
premature babies. It can cause babies to need extra oxygen and help with
- RDS occurs most often in babies born before the 28th week of
pregnancy and can be a problem for babies born before 37 weeks of pregnancy.
- RDS typically gets worse over the first 2 to 3 days. It then
gets better with treatment.
- Treatment may include extra oxygen, surfactant replacement,
- Preventing a premature birth is the main way to prevent
Tips to help you get the most from a visit to your child’s healthcare provider:
- Know the reason for the visit and what you want to happen.
- Before your visit, write down questions you want answered.
- At the visit, write down the name of a new diagnosis, and any new medicines, treatments,
or tests. Also write down any new instructions your provider gives you for your child.
- Know why a new medicine or treatment is prescribed and how it will help your child.
Also know what the side effects are.
- Ask if your child’s condition can be treated in other ways.
- Know why a test or procedure is recommended and what the results could mean.
- Know what to expect if your child does not take the medicine or have the test or procedure.
- If your child has a follow-up appointment, write down the date, time, and purpose
for that visit.
- Know how you can contact your child’s provider after office hours. This is important
if your child becomes ill and you have questions or need advice.