Respiratory distress syndrome
- Article
- 2021-02-04
RDS is more common in premature newborns because their lungs cannot make enough surfactant. Surfactant is a foaming substance that expands the lungs completely so that newborns can breathe air after birth.
Without enough surfactant, the lungs collapse and the newborn has to work hard to breathe. He or she may 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 lack of oxygen at birth or in the first few hours that follow. The lack of oxygen can damage the baby's brain and other organs if not treated immediately.
RDS can turn into bronchopulmonary dysplasia or BPD over time. This is another breathing disorder that can 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 of gestation, they can be diagnosed with BPD. Some of the life-saving treatments used for RDS can contribute to BPD. Some newborns with RDS recover and never develop BPD.
Thanks to better treatments and medical advances, most newborns survive with RDS. However, these babies may need additional medical care after returning home. Some babies have complications from RDS or its treatments. Serious complications include chronic respiratory problems such as asthma and BPD; Limited view; and movement, learning or behavioral problems.
Symptoms
Signs and symptoms of RDS include:
- Grunting noises
- Rapid, shallow breathing
- When breathing, sharply pull in the muscles between the ribs
- Widening of the nostrils or flaring with each breath
The newborn may also have pauses in breathing for a few seconds. This condition is called apnea.
Therapy
Treatment for RDS usually begins as soon as a newborn is born, sometimes in the delivery room. Treatments for RDS include surfactant replacement therapy, respiratory support from a ventilator or nasal continuous positive airway pressure (NCPAP) machine, or other supportive treatments.
Most newborns showing signs of RDS are quickly transferred to a neonatal intensive care unit (NICU). There they are treated 24 hours a day by healthcare professionals specializing in the treatment of premature newborns.
Surfactant replacement therapy
Surfactant helps keep the lungs open so that a newborn can breathe air as soon as he or she is born. Babies with RDS are given surfactant until their lungs are able to make the substance themselves. Surfactant is usually administered through a breathing hose. The tube allows the surfactant to pass directly into the baby's lungs.
After the surfactant is administered, the breathing tube is connected to a ventilator, or the baby can receive breathing support from NCPAP.
Surfactant is often given in the delivery room immediately after birth to prevent or treat RDS. It can also be given several times in the days that follow, until the baby can breathe better.
Some women are given medicines called corticosteroids during pregnancy. These drugs can accelerate the production of surfactants and the development of the lungs in a fetus. Even if you've been on these drugs, your newborn may still need surfactant replacement therapy after birth.
Respiratory support
Newborns with RDS often need respiratory support or oxygen therapy until their lungs start making enough surfactant. Until recently, a mechanical fan was usually used.The ventilator was connected to a breathing hose that ran through the newborn's mouth or nose into the trachea.
Today, more and more newborns are receiving respiratory support from NCPAP. NCPAP gently pushes air into the baby's lungs through protrusions in the newborn's nostrils.
Other supportive treatments
Treatment at the NICU helps reduce stress for babies and meet their basic needs for warmth, nutrition and protection. Such treatment can be:
- Monitor fluid intake to make sure fluid is not building up in the baby's lungs.
- Checking the amount of oxygen in the blood with sensors on fingers or toes.
- Administer fluids and nutrients through needles or tubes that are inserted into the veins of the newborn. This helps prevent malnutrition and promotes growth. Nutrition is crucial for the growth and development of the lungs. Later, babies can be fed breast milk or newborn formula through feeding tubes that are passed through their nose or mouth and down their throat.
- Measuring blood pressure, heart rate, breathing and temperature by means of sensors stuck to the baby's body.
- Use a radiant heater or incubator to keep newborns warm and reduce the risk of hypothermia.
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