What Is Respiratory Distress Syndrome?
Respiratory distress syndrome (RDS) is a breathing
problem that sometimes affects babies born about 6 weeks or more before their
due dates. Their lungs aren't developed enough to make surfactant
(sur-FAK-tant). Surfactant is a liquid that coats the inside of the lungs and
keeps them open so that the baby can breathe in air once he or she is born.
Without surfactant, the lungs collapse and the baby
has to work hard to breathe. The baby might not be able to breathe in enough
oxygen to support the body's organs.
Most infants who develop RDS show signs of breathing
problems at birth or within the next few hours. If they're not given the right
treatment, their brains and other organs may suffer from the lack of oxygen.
Overview
RDS is one of the most common lung disorders in
premature babies. It affects about 10 of every 100 premature infants in the
United States, or about 40,000 babies, each year. In fact, nearly all babies
born before 28 weeks of pregnancy develop RDS. Full-term infants rarely get it.
RDS is different from
bronchopulmonary
dysplasia (BPD), another breathing condition that affects premature babies.
While RDS usually develops in the first 24 hours after birth, BPD usually
develops within the next week or two. Doctors aren't sure exactly what causes
BPD, but they do know that most babies who develop it are born with serious
RDS.
All of these babies lack surfactant. But the babies
with RDS who go on to develop BPD have less developed lungs than the babies
with RDS who recover. Their lungs usually have fewer, larger alveoli, with
fewer tiny blood vessels than normal. The blood vessels are needed to move
oxygen from the alveoli into the bloodstream.
Outlook
Thanks to recent medical advances, most babies with
RDS who weigh more than 2 pounds at birth now survive and have no long-term
health or development problems.
Other Names for Respiratory Distress Syndrome
- Hyaline membrane disease (HMD)
- Neonatal respiratory distress syndrome
- Infant respiratory distress syndrome
What Causes Respiratory Distress Syndrome?
A lack of surfactant in a premature baby's lungs
causes respiratory distress syndrome (RDS). Surfactant is a liquid that a
fetus' lungs start making at around 26 to 34 weeks of pregnancy. It coats the
insides of the lungs and keeps them open so they can breathe in air after
birth. Without surfactant, the lungs collapse when the baby exhales. The baby
then has to work hard to breathe.
Other factors that can increase the chances your
baby will develop RDS include:
Some infants born at term develop RDS because they
have abnormal genes for surfactant.
What Are the Signs and Symptoms of Respiratory
Distress Syndrome?
Signs and symptoms of respiratory distress syndrome
(RDS) usually appear at birth or within the next few hours. They include:
- Rapid, shallow breathing
- Sharp pulling in of the chest below the ribs
with each breath taken in
- Grunting sounds during exhalation
- Flaring of the nostrils during breathing
The baby may also stop breathing for a few seconds
every now and then. This is called apnea.
Depending on how severe the RDS is, these babies
also may develop other serious medical problems, including:
- A collapsed lung.
- Leakage of air from the lung into the chest
cavity. This is rare.
-
Bronchopulmonary dysplasia, another lung disease in premature infants.
- Bleeding in the brain, which can lead to delayed
mental development, mental retardation, and
cerebral palsy.
- Sepsis, an infection of the bloodstream.
- Bleeding in the lung.
- Blindness and other eye problems.
- Kidney failure, only in the most severe cases.
- Necrotizing enterocolitis, a disease of the
bowel.
How Is Respiratory Distress Syndrome
Diagnosed?
Doctors usually begin treating respiratory distress
syndrome (RDS) as soon as the baby is born. At the same time, they do several
tests to rule out any other conditions that could be causing the baby's
breathing problems. The tests also can confirm that the doctors have diagnosed
the condition correctly.
The tests include:
- Chest x ray. A chest x ray takes a picture of the heart and
lungs. It shows signs of RDS. A chest x ray also can identify complications,
such as a collapsed lung, that may require urgent treatment.
- Blood tests. Blood samples are checked to see
whether the baby has enough oxygen in his or her blood. These tests also can
rule out infection and sepsis as a cause of the breathing problems.
- Echocardiogram.
This test uses sound waves to create a moving picture of the heart. An
echocardiogram is used to rule out
congenital
heart defects as the cause of the breathing problems.
How Is Respiratory Distress Syndrome Treated?
Treatment of respiratory distress syndrome (RDS)
usually begins as soon as the baby is born, sometimes in the delivery room.
Most infants who show signs of RDS are quickly moved to a special intensive
care unit called a neonatal intensive care unit (NICU). There they receive
around-the-clock treatment from a group of health care professionals who
specialize in treating premature infants.
The most important treatments for RDS are:
- Surfactant replacement therapy
- Breathing support
Surfactant Replacement Therapy
The baby is given surfactant until his or her lungs
have developed enough to start making their own surfactant. Surfactant usually
is given through a tube that's attached to a breathing machine. The machine
pushes the surfactant directly into the baby's lungs.
Surfactant may be given right after birth in the
delivery room to try to prevent or treat RDS. It can be given two to four more
times over the next few days, until the baby is able to breathe on his or her
own.
Breathing Support
Babies with RDS often are put on a machine that
helps them breathe until their lungs have developed enough to start making
their own surfactant. Until recently, these babies usually were put on a
mechanical ventilator that was connected to a breathing tube that ran through
the baby's mouth or nose into the windpipe.
Today, more and more babies are receiving breathing
support from a nasal continuous positive airway pressure (NCPAP) machine, which
pushes air into the baby's lungs through prongs in the nostrils.
Other Types of Treatment
Other treatments for babies with RDS include:
Medicines
Doctors usually give the baby antibiotics to control
infections.
Supportive Therapy
Treatment in the NICU is designed to limit stress
on the baby and meet his or her basic needs of warmth, nutrition, and
protection. Such treatment usually includes:
- Using a radiant warmer or incubator to keep the
baby warm and reduce the chances of infection.
- Ongoing monitoring of blood pressure, heart
rate, breathing, and temperature through sensors taped to the baby's body.
- Using a sensor on a finger or toe to monitor the
amount of oxygen in the baby's blood.
- Giving fluids and nutrients through a needle or
tube inserted into a vein to prevent malnutrition and promote growth. Nutrition
is critical to the growth and development of the lungs. Later, your baby may be
given milk through a tube that's passed through his or her nose into the mouth.
- Monitoring fluid intake to make sure that fluid
doesn't build up in the baby's lungs.
How Can Respiratory Distress Syndrome Be
Prevented?
You can do certain things to help ensure that your
baby isn't born before his or her lungs have developed completely.
They include:
- Seeing your doctor regularly during your
pregnancy
- Eating right
- Avoiding tobacco smoke, alcohol, and illegal
drugs
- Controlling any ongoing medical conditions you
have
- Preventing infection
Your doctor may give you injections of a
corticosteroid medicine if it looks as though you may give birth too early.
This medicine can speed up surfactant production and development of the lungs,
brain, and kidneys in the fetus. Usually, within about 24 hours after you start
taking the medicine, the fetus' lungs start making enough surfactant, and the
baby's chances of developing respiratory distress syndrome (RDS) are reduced.
If the baby does develop RDS, it will probably be relatively mild.
If you start taking this medicine at least 15 hours
before you deliver, it also can reduce the chances that your baby will have any
bleeding into the brain or develop necrotizing enterocolitis, a serious
condition that affects the baby's intestines.
Living With Respiratory Distress Syndrome
Caring for a premature infant can be challenging.
You may experience:
- Emotional pain, including feelings of guilt,
anger, and depression
- Anxiety about your baby's future
- A feeling of a lack of control over the
situation
- Financial stress
- Problems relating to the baby in the neonatal
intensive care unit (NICU)
- Fatigue (tiredness)
Things you can do to help yourself during this
difficult time include:
- Taking care of your health so that you have
enough energy to deal with this situation.
- Breast feeding your baby.
- Learning as much as you can about what goes on
in the NICU so that you can help your baby during his or her stay there and
begin to bond with the baby before he or she comes home.
- Learning as much as you can about your baby's
condition and what is involved in daily care so you can ask the right questions
and feel more confident about your ability to care for him or her at home.
- Seeking out support from family and friends, as
well as hospital personnel. Ask the case manager or social worker at the
hospital about what you'll need after the baby leaves the hospital. The
physicians and nursing staff can assist with questions about your infant's
care. Also ask whether there is a support group in your community.
- Enjoying your new baby, spending as much time
with him or her as you can, and looking forward to a happy future.
Your baby also may need special care after leaving
the NICU, including:
- Special hearing and eye examinations
- Speech or physical therapy
- Specialty care for other medical problems caused
by premature birth
Key Points
- Respiratory distress syndrome (RDS) is a
breathing problem that sometimes affects babies born about 6 weeks or more
before their due dates.
- Most infants who develop RDS show signs of
breathing problems at birth or within the next few hours. If they're not given
the right treatment, their brains and other organs may suffer from the lack of
oxygen.
- RDS affects about 10 of every 100 premature
infants in the United States, or about 40,000 babies, each year. Nearly all
babies born before 28 weeks of pregnancy develop RDS. Full-term infants rarely
get it.
- A lack of surfactant in a premature baby's lungs
causes RDS. Surfactant is a liquid that coats the insides of a fetus' lungs and
keeps them open so they can breathe in air after birth.
- Factors that can increase the chances your baby
will develop RDS include if you have
diabetes mellitus,
cesarean delivery, stress during delivery, and infection. Some
infants born at term develop RDS because they have abnormal genes for
surfactant.
- Signs and symptoms of RDS at birth include rapid,
shallow breathing; sharp pulling in of the chest below the ribs with each
breath taken in; grunting sounds during exhalation; and flaring of the nostrils
during breathing.
- Doctors usually begin treating RDS as soon as the
baby is born. At the same time, they do several tests to rule out any other
conditions that could be causing the baby's breathing problems. These include
blood tests,
chest x ray, and
echocardiogram.
- The most important treatments for RDS are
surfactant replacement therapy and breathing support. Other treatments include
medicines, supportive therapy, and treatment for
patent
ductus arteriosus, a condition that affects some premature infants.
- Most infants who show signs of RDS are moved to a
special intensive care unit in the hospital called a neonatal intensive care
unit (NICU). There they receive around-the-clock treatment from a group of
health care professionals who specialize in treating premature infants.
- Your baby also may need special care after
leaving the NICU, including special hearing and eye exams, speech or physical
therapy, and specialty care for other medical problems caused by premature
birth.
- Thanks to recent medical advances, most babies
with RDS who weigh more than 2 pounds at birth now survive and have no
long-term health or development problems.
Links to Other Information About Respiratory
Distress Syndrome
NHLBI Resources
Non-NHLBI Resources
Clinical Trials
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