Neonatal Respiratory Distress Syndrome

    Neonatal respiratory distress syndrome (RDS) is a disease that often seen in the premature babies. This condition makes it difficult for the baby to breathe.


    Neonatal 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 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 of the RDS cases occur in the babies born before 37 to 39 weeks. Premature babies have a higher chance of having RDS after the birth. The problem is uncommon in babies born with full-term (after 39 weeks).

    Other factors that can increase the risk of RDS include:

    • Brother or sister who had this RDS
    • Diabetic mother
    • Caesarean delivery or induction of labor before the baby is full-term
    • Problems with delivery that reduce blood flow to the baby
    • Multiplet pregnancy (twins or more)
    • Rapid labor


    Most of the time, symptoms appear within minutes of birth. However, in some cases, they may not be seen for several hours. Symptoms may include:

    • Bluish color of the skin and mucus membranes (cyanosis)
    • Brief pause in breathing (apnea)
    • Decreased urine output
    • Nasal flaring
    • Rapid breathing
    • Shallow breathing
    • Shortness of breath and grunting sounds while breathing
    • Unusual breathing movement (such as drawing back of the chest muscles with breathing).

    The following tests are used to detect the condition:

    • Blood gas analysis will show low oxygen level and will report excess acid in the body fluids
    • Chest x-ray shows a “ground glass” appearance to the lungs that is typical of the disease. This often develops 6 to 12 hours after birth.
    • Lab tests will helps to rule out infection as a cause of breathing problems


    Babies 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. Treatment is to be monitored carefully to avoid any side effects. Giving extra surfactant to a sick infant has been shown to be helpful. More research still needs to be done on which babies should get this treatment and how much surfactant to use. Assisted ventilation with a ventilator can save life for some babies. But using this breathing machine can damage the lung tissue, so the treatment should be avoided if  possible. Babies may need this treatment if they have the following symptoms:

    • High level of carbon dioxide in the blood
    • Low blood oxygen
    • Low blood pH (acidity)
    • Repeated pauses in breathing

    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.

    Babies with RDS need closely monitored care. This includes:

    • Having a calm setting
    • Gentle handling
    • Staying at an ideal body temperature
    • Carefully managing fluids and nutrition
    • Treating infections right away