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Respiratory Distress Syndrome (RDS) in Premature Babies

What is respiratory distress syndrome in premature babies?

What is respiratory distress syndrome in premature babies?

Respiratory distress syndrome (RDS) is a common problem in premature babies. It causes babies to need extra oxygen and help with breathing. The course of illness with RDS depends on:

  • The size and gestational age of your baby
  • How serious the illness is
  • Whether your baby has an infection
  • Whether your baby has a heart defect called patent ductus arteriosus
  • Whether your baby needs a machine to help him or her breathe (ventilator)

RDS typically gets worse over the first 48 to 72 hours. It then gets better with treatment.

What causes RDS in premature babies?

RDS occurs when there is not enough surfactant in the lungs. This 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. If a baby is premature, he or she may not have made enough surfactant yet.

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 re-inflate the collapsed airways.

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 eventually gives up. A ventilator must do the work of breathing instead.

Which premature babies are at risk for RDS?

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.

Although most babies with RDS are premature, other things can raise the risk of getting the disease. These include:

  • A baby who is male or Caucasian
  • Previous birth of baby with RDS
  • Cesarean delivery
  • Perinatal asphyxia
  • Cold stress. This is a condition in which the baby make less surfactant.
  • Infection
  • Multiple births. Multiple birth babies are often premature.
  • Infants of mothers with diabetes. A baby with too much insulin in his or her body can delay making surfactant.
  • Babies with a heart defect called patent ductus arteriosus

What are the symptoms of RDS in premature babies?

These are the most common symptoms of RDS:

  • Breathing problems at birth that get worse
  • Blue skin color (cyanosis)
  • Flaring of the nostrils
  • Rapid breathing
  • Grunting sounds with breathing
  • Ribs and breastbone pulling in when the baby breathes (chest retractions)

The symptoms of RDS usually peak by the third day. They may go away quickly when the baby starts to urinate. When a baby gets better, he or she needs less oxygen and mechanical help to breathe.

The symptoms of RDS may look like other health conditions. Make sure your baby sees his or her healthcare provider for a diagnosis.

How is RDS in premature babies diagnosed?

RDS is usually diagnosed by a combination of the following:

  • Baby’s appearance, color, and breathing efforts. These can point to a baby's need for oxygen..
  • Chest X-rays of lungs. X-rays make images of bones and organs.
  • Blood gas tests. These measure the amount of oxygen, carbon dioxide and acid in the blood. They often 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.

How is RDS in premature babies treated?

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 the baby's windpipe (trachea)
  • Mechanical breathing machine (ventilator). This does the work of breathing 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 it is used as a "rescue" method. Surfactant is a liquid given through the breathing tube.
  • Medicines to help calm the baby and ease pain during treatment

What are the complications of RDS in premature babies?

Babies sometimes have complications from RDS treatment. As with any disease, more severe cases often have greater risks for complications. Some complications of RDS include:

  • Lungs leak air into the chest, the sac around the heart, or elsewhere in the chest.
  • Chronic lung disease (bronchopulmonary dysplasia)

How can RDS in premature babies be prevented?

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. 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 working.   

Key points about RDS in premature babies

  • Respiratory distress syndrome (RDS) is a common problem in premature babies. It can cause babies to need extra oxygen and help with breathing.
  • RDS occurs most often in babies born before the 28th week of pregnancy.
  • Treatment may include extra oxygen, surfactant replacement, and medicines.
  • Preventing a premature birth is the main way to prevent RDS.

Next steps

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.

Medical Reviewers:

  • Berry, Judith, PhD, APRN
  • Goode, Paula, RN, BSN, MSN