Respiratory distress syndrome, infant

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Other Names: Hyaline membrane disease; Infantile respiratory distress syndrome; IRDS; NRDS; Neonatal respiratory distress syndrome; RDS - infants

Respiratory distress syndrome (RDS) is a common breathing disorder that affects newborns. RDS occurs most often in babies born preterm, affecting nearly all newborns who are born before 28 weeks of pregnancy. Less often, RDS can affect full term newborns.

RDS is more common in premature newborns because their lungs are not able to make enough surfactant. Surfactant is a foamy substance that keeps the lungs fully expanded so that newborns can breathe in air once they are born.

Without enough surfactant, the lungs collapse and the newborn has to work hard to breathe. He or she might not be able to breathe in enough oxygen to support the body's organs. Most babies who develop RDS show signs of breathing problems and a lack of oxygen at birth or within the first few hours that follow. The lack of oxygen can damage the baby's brain and other organs if not treated promptly.

RDS may change over time to become bronchopulmonary dysplasia, or BPD. This is another breathing disorder that may affect babies, especially premature babies.

RDS usually develops in the first 24 hours after birth. If premature newborns still have breathing problems by the time they reach 36 weeks gestation, they may be diagnosed with BPD. Some of the life-saving treatments used for RDS may contribute to BPD. Some newborns who have RDS recover and never get BPD.

Respiratory distress of the newborn.jpg

Cause

RDS is a type of neonatal respiratory disease that is caused most often by a lack of surfactant in the lungs. A fetus's lungs start making surfactant during the third trimester of pregnancy, or weeks 26 through labor and delivery. Surfactant coats the insides of the air sacs, or alveoli, in the lungs. This helps keep the lungs open so breathing can occur after birth. To understand respiratory distress syndrome, it helps to learn about how the lungs work.

Without enough surfactant, the lungs may collapse when the newborn exhales. The newborn then has to work harder to breathe. He or she might not be able to get enough oxygen to support the body's organs.

Some full-term newborns develop RDS because they have faulty genes that affect how their bodies make surfactant.

Risk Factors

Certain factors may increase the risk that your newborn will have RDS. These factors include:

  • Infection
  • Premature delivery. The earlier your baby is born, the greater his or her risk for RDS. Most cases of RDS occur in babies born before 28 weeks of pregnancy.
  • Problems with your baby’s lung development
  • Stress during your baby's delivery, especially if you lose a lot of blood
  • You having diabetes
  • Your baby also is at greater risk for RDS if you require an emergency cesarean delivery before your baby is full term. You may need an emergency cesarean delivery because of a condition, such as a detached placenta, that puts you or your newborn at risk.
  • Planned cesarean deliveries that occur before a baby's lungs have fully matured can also increase your baby’s risk for RDS. Your doctor can do tests before delivery that show whether it is likely that your baby's lungs are fully developed. These tests determine the age of the fetus or lung maturity.

Signs and symptoms

Signs and symptoms of RDS include:

  • Grunting sounds
  • Rapid, shallow breathing
  • Sharp pulling inward of the muscles between the ribs when breathing
  • Widening of the nostrils, or flaring, with each breath
  • The newborn also may have pauses in breathing that last for a few seconds. This condition is called apnea.

Complications

Depending on the severity of a newborn's RDS, he or she may develop other medical problems.

  • Bleeding in the brain, which can delay cognitive development or cause intellectual disabilities or cerebral palsy
  • Blood and blood vessel complications. Newborns who have RDS may develop sepsis. This infection can be life threatening.
  • Bowel disease called necrotizing enterocolitis
  • Impaired vision, including blindness
  • Kidney failure
  • Lung complications: These may include atelectasis; leakage of air from the lung into the chest cavity, called pneumothorax, a type of pleural disorder; and bleeding in the lung, or hemorrhage. Some of the life-saving treatments used for RDS may cause bronchopulmonary dysplasia.
  • Patent ductus arteriosus, a type of congenital heart defect. The ductus arteriosus connects pulmonary arteries to the aorta. If it remains open, it can strain the heart and increase blood pressure in the lung arteries.

Diagnosis

RDS is common in premature newborns. Thus, doctors usually recognize and begin treating the disorder as soon as babies are born. Doctors also do several tests to rule out other conditions that could be causing a newborn's breathing problems. The tests also can confirm that the doctors have diagnosed the condition correctly.

The tests include:

  • Chest X-ray to show whether a newborn has signs of RDS. A chest X-ray also can detect problems, such as a collapsed lung, that may require urgent treatment.
  • Blood tests to see whether a newborn has enough oxygen in the blood. Blood tests also can help find out whether an infection is causing the newborn's breathing problems.
  • Echocardiography (echo) to rule out heart defects as the cause of the newborn's breathing problems.

Treatment

Treatment for RDS usually begins as soon as a newborn is born, sometimes in the delivery room. Treatments for RDS include surfactant replacement therapy, breathing support from a ventilator or nasal continuous positive airway pressure (NCPAP) machine, or other supportive treatments.

Most newborns who show signs of RDS are quickly moved to a neonatal intensive care unit (NICU). There they receive around-the-clock treatment from healthcare professionals who specialize in treating premature newborns.

Surfactant replacement therapy Babies who have RDS get surfactant until their lungs are able to start making the substance on their own. Surfactant is usually given through a breathing tube. The tube allows the surfactant to go directly into the baby's lungs. Once the surfactant is given, the breathing tube is connected to a ventilator, or the baby may get breathing support from NCPAP. Surfactant often is given right after birth in the delivery room to try to prevent or treat RDS. It also may be given several times in the days that follow, until the baby is able to breathe better. Some women are given medicines called corticosteroids during pregnancy. These medicines can speed up surfactant production and lung development in a fetus. Even if you had these medicines, your newborn may still need surfactant replacement therapy after birth.

Breathing support Newborns who have RDS often need breathing support, or oxygen therapy, until their lungs start making enough surfactant. Until recently, a mechanical ventilator usually was used. The ventilator was connected to a breathing tube that ran through the newborn's mouth or nose into the windpipe.

The medication(s) listed below have been approved by the Food and Drug Administration (FDA) as orphan products for treatment of this condition.

  • Pulmonary surfactant replacement, porcine (Brand name: Curosurf)Treatment (rescue) of respiratory distress syndrome in premature infants.
  • Colfosceril palmitate, cetyl alcohol, tyloxapol (Brand name: Exosurf Neonatal for Intratracheal Suspension)Treatment of established hyaline membrane disease at all gestational ages.
  • Surface active extract of saline lavage of bovine lungs (Brand name: Infasurf®) Treatment and prevention of respiratory failure due to pulmonary surfactant deficiency in preterm infants.
  • Beractant (Brand name: Survanta intratracheal suspension)Treatment of ("rescue") of premature infants with RDS confirmed by x-ray and requiring mechanical ventilation.

NIH genetic and rare disease info

Respiratory distress syndrome, infant is a rare disease.

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