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Respiratory Distress
Syndrome (RDS)

Respiratory distress syndrome (RDS) in newborns is typically caused by birth before 28 weeks. At this point, the baby’s lungs have not started making surfactant, a substance that helps keep the lungs inflated. When a baby is born before 28 weeks, they usually cannot breathe on their own. In specific cases, RDS affects babies born after 28 weeks.

Symptoms

Common symptoms of RDS in newborns include:

  • A blue tint to the lips and skin
  • Fast breathing
  • A grunting when breathing
  • Flared nostrils
  • Ribs visibly go inward when the baby breaths

RDS is typically noticeable right after birth and only gets worse after birth. If you are not in the hospital when your baby is born and notice any of these symptoms, seek help right away.

Causes & Risk Factors

RDS is caused by a lack of surfactant in a newborn’s lungs. Surfactant is typically produced between 24 and 28 weeks in utero, which is why RDS is seen the most in premature births. In rare cases, underdeveloped lungs can be due to genetic reasons.

Risk factors for RDS include a mother with diabetes, an underweight baby, a baby with underdeveloped lungs, siblings who had RDS, C-section, lack of blood flow to the baby during delivery, quick labour, or having twins or triplets.

While premature babies are the most likely candidates to develop RDS, babies that developed to term can have RDS when any of the risk factors listed above are involved.

Reference Articles

Diagnosis & Complications

If a newborn has the symptoms of RDS, a doctor will run tests to rule out other breathing issues. They may order chest X-rays, heart echocardiograms to check for any problems with the heart, and blood tests to ensure that the newborn has no infections. A chest X-ray will enable a doctor to make a definitive diagnosis after any other issues have been ruled out.

Complications of RDS include a collapsed lung(pneumothorax), air buildup in the chest between the lungs (pneumomediastinum), and air buildup between the heart and the sac around the heart (pneumopericardium). Additionally, newborns with RDS may have issues with lung development and growth, bleeding in the brain, cognitive impairment, infections, and impaired vision.

Treatment & Management

 If a baby is premature but comes after week 28 of pregnancy, a steroid shot is often given to the mother to help prevent RDS in the foetus. However, RDS happens in almost every baby born before 28 weeks. Luckily, it can effectively be treated.

Treatment options include:

  • Nasal continuous positive airway pressure(nCPAP) – an nCPAP pushes high flow oxygen through the baby’s nose to help the newborn with the work of breathing
  • Surfactant replacement – sometimes, newborns struggle to breathe even with a nCPAP. In this case, giving a surfactant-like substance through a breathing tube is considered. However, there are potential complications associated with using a breathing tube on a newborn that the provider and the parents will discuss
  • Mechanical ventilation – this is one of the last resorts for babies with RDS. The newborn is on a machine that breathes for them 24 hours a day. It is a form of life support and comes with possible complications, like injury to the airway and respiratory system.
  • Fluids and nutrients – newborns with RDS will need supportive therapy in the form of fluids to keep them hydrated and nutrients to keep them strong and promote growth

Every newborn has a different journey to recovering from RDS, and not every newborn survives. However, many do, and neonatal therapy is only getting more advanced.

 
 
 

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