Newborn Breathing Conditions Respiratory Distress Syndrome (RDS)

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RDS is a common breathing disorder that affects newborns. RDS occurs most often in babies born before their due date, usually before 28 weeks of pregnancy. Less often, RDS can affect full-term newborns.

Most newborns who have RDS survive. However, these babies may need extra medical care after going home. Some babies have complications from RDS or its treatment, including the development of another lung condition called bronchopulmonary dysplasia.

Symptoms of RDS include:

• Fast and shallow breathing
• Grunting
• Flaring of the nostrils with each breath
• Bluish tone to a baby’s skin and lips
• Pulling inward of the muscles between the ribs when breathing

RDS is common in premature newborns, but doctors may need to run tests to rule out other types of newborn breathing conditions. After doing a physical examination to look at a newborn’s symptoms, your provider may order one or more of the tests below.

• Lung imaging tests such as chest X-rays show how well the lungs and heart are working. X-rays are used to diagnose most types of newborn breathing conditions.
• Heart tests such as an echocardiogram can check for a possible congenital heart defect.
• Blood tests look for an infection.

RDS is caused by a lack of surfactant in the lungs. The lungs of a fetus start making surfactant during the third trimester, which starts after the 26th week of pregnancy.

Surfactant is a foamy substance that keeps the lungs fully expanded so that newborns can breathe in air once they are born. Without it, the lungs collapse, and the newborn must work hard to breathe. This can cause the baby’s organs to be without necessary levels of oxygen.

If a full-term baby develops RDS, it may be because they have faulty genes that affect how their bodies make surfactant.

The earlier a baby is born, the more likely they are to have RDS that cannot be prevented. Nearly all babies born before 28 weeks of pregnancy will have RDS. With treatment, many newborns that are diagnosed with RDS will recover.

Some common treatments include those listed below.

• Nasal continuous positive airway pressure (nCPAP): This device provides breathing support by gently pushing air into the baby's lungs through prongs placed in the nose.
• Surfactant replacement therapy: This can be used if a newborn struggles to breathe despite the use of nCPAP. Sometimes, giving an infant surfactant requires the use of a breathing tube. If so, because of the possible complications, your baby’s provider will help you consider the risks and benefits of the procedure.
• Mechanical ventilation: This is used only in very serious cases of RDS. A ventilator is a machine that takes over the work of breathing and is a form of life support. The machine connects to a breathing tube that runs through a newborn’s mouth or nose and into the windpipe. Babies that require ventilation are more likely to develop bronchopulmonary dysplasia. They may also develop health problems from the breathing tube or ventilator, such as an airway or lung injury.
• Fluids and nutrients: These may be given to help prevent malnutrition and promote growth. Nutrition is critical to the growth and development of the lungs.

If a baby born with RDS still requires breathing support by the time they reach their original due date, they are diagnosed with a condition called bronchopulmonary dysplasia.

Depending on how serious their RDS is, they may also develop other medical conditions, including:

• Bleeding in the brain, which can delay cognitive development or cause intellectual disabilities or cerebral palsy
• Lung complications, such as air leaking from the lung into the chest cavity, called pneumothorax, or bleeding in the lungs
• Impaired vision
• Infections that can cause sepsis