Neonatal respiratory distress syndrome

Alternative Names

Treatment

High-risk and premature infants require prompt attention by a neonatal resuscitation team.

Despite greatly improved RDS treatment in recent years, many controversies still exist. Delivering artificial surfactant directly to the infant's lungs can be enormously important, but how much should be given and who should receive it and when is still under investigation.

Infants will be given warm, moist oxygen. This is critically important, but needs to be given carefully to reduce the side effects associated with too much oxygen.

A breathing machine can be lifesaving, especially for babies with the following:

• High levels of carbon dioxide in the arteries
• Low blood oxygen in the arteries
• Low blood pH (acidity)

It can also be lifesaving for infants with repeated breathing pauses. There are a number of different types of breathing machines available. However, the devices can damage fragile lung tissues, and breathing machines should be avoided or limited when possible.

A treatment called continuous positive airway pressure (CPAP) that delivers slightly pressurized air through the nose can help keep the airways open and may prevent the need for a breathing machine for many babies. Even with CPAP, oxygen and pressure will be reduced as soon as possible to prevent side effects associated with excessive oxygen or pressure.

A variety of other treatments may be used, including:

• Extracorporeal membrane oxygenation (ECMO) to directly put oxygen in the blood if a breathing machine can't be used
• Inhaled nitric oxide to improve oxygen levels

It is important that all babies with RDS receive excellent supportive care, including the following, which help reduce the infant's oxygen needs:

• Few disturbances
• Gentle handling
• Maintaining ideal body temperature

Infants with RDS also need careful fluid management and close attention to other situations, such as infections, if they develop.

Outlook (Prognosis)

The condition often worsens for 2 to 4 days after birth with slow improvement thereafter. Some infants with severe respiratory distress syndrome will die, although this is rare on the first day of life. If it occurs, it usually happens between days 2 and 7.

Long-term complications may develop as a result of oxygen toxicity, high pressures delivered to the lungs, the severity of the condition itself, or periods when the brain or other organs did not receive enough oxygen.

Possible Complications

Air or gas may build up in:

• The space surrounding the lungs (pneumothorax)
• The space in the chest between two lungs (pneumomediastinum)
• The area between the heart and the thin sac that surrounds the heart (pneumopericardium)

Other complications may include:

• Bleeding into the brain (intraventricular hemorrhage of the newborn)
• Bleeding into the lung (sometimes associated with surfactant use)
• Blood clots due to an umbilical arterial catheter
• Bronchopulmonary dysplasia
• Delayed mental development and mental retardation associated with brain damage or bleeding
• Retinopathy of prematurity and blindness

When to Contact a Medical Professional

This disorder usually develops shortly after birth while the baby is still in the hospital. If you have given birth at home or outside a medical center, seek emergency attention if your baby develops any difficulty breathing.

References

Cloherty J, Stark A, Eichenwald E. Manual of Neonatal Care. 5th ed. Lippincott, Wilkins and Williams; 2003.

Cole FS. Defects in surfactant synthesis: clinical implications. Pediatr Clin North Am. Oct 2006; 53(5): 911-27.

Courtney SE. Continuous positive airway pressure and noninvasive ventilation. Clin Perinatol. Mar 2007; 34(1): 73-92.

Kinsella JP, Inhaled nitric oxide in the premature newborn. J Pediatr. Jul 2007; 151(1): 10-5.

Lampland AL. The role of high-frequency ventilation in neonates: evidence-based recommendations. Clin Perinatol. Mar 2007; 34(1): 129-44.

Stevens TP. Surfactant replacement therapy. Chest. May 2007; 131(5): 1577-82.