Infant Respiratory Distress Syndrome
What is it?
Infant respiratory distress syndrome is a breathing disorder that is present at birth. Infant respiratory distress syndrome was previously known as hyaline membrane disease. You may also see it referred to as RDS, or infant
RDS.
Who gets it?
RDS usually affects premature infants. The more premature the infant, the higher the risk of RDS. It is also more likely in infants with diabetic mothers.
What causes it?
Tiny air sacs called alveoli are located at the tips of the body’s smallest breathing tubes, called the bronchi. The alveoli are responsible for passing oxygen into the blood. In the last stages of pregnancy, from 34 to 37 weeks, the cells in the alveoli normally produce a substance called surfactant. Surfacant reduces the surface tension of fluids that coat the lungs so the air sacs can expand at birth and the infant can breathe normally. When an infant is born prematurely, the cells in the alveoli do not yet have enough surfacant formed and the alveoli cannot expand. Very premature babies may have lungs that are so stiff they cannot breathe on their own. Or, the baby may be able to start breathing, but the “airless” lungs collapse and cause respiratory distress.
What are the symptoms?
The breathing of an infant with RDS will be rapid and labored either at birth or within a few hours of birth. The chest also appears to move inward when the baby takes a breath, and the baby grunts when exhaling. In severe cases, the immature muscles responsible for breathing become tired. When this happens, breathing becomes ineffective, the oxygen level in the blood becomes low, and the baby’s skin and lips appear blue. Complications include collapsed lung
(pneumothorax) and bleeding in the brain.
How is it diagnosed?
Infant RDS is diagnosed based upon the symptoms present at birth and the known risk factors for the infant (premature birth or diabetic mother). Diagnostic tests include a chest x-ray, which will show whether the infant’s lungs are fully expanded, and a test of the oxygen level in the blood. Blood oxygen level can be checked by taking a blood sample or by clipping a device called an oximeter to the earlobe. If complications during pregnancy indicate that a premature birth is likely, doctors can test the amniotic fluid for
surfacant. To do this, a long thin needle is placed through the abdomen into the uterus and a fluid sample is removed. This procedure is called amniocentesis. Doctors can use this test to track the fetus’ lung development so delivery can be delayed as long as possible until the lungs are mature. Doctors can even measure the amount of surfacant in the lungs from a sample of fluid after your water breaks.
What is the treatment?
If your baby’s birth cannot be delayed until he or she is full term, doctors can give you a steroid
hormone, called a corticosteroid. This drug will cross the placenta and help the fetus’ lungs to produce surfactant, as well as reduce the risk of bleeding in the brain after birth even if the baby develops
RDS. Infants born with mild RDS may need nothing more than an oxygen hood for a short time to assist with breathing. Oxygen can also be delivered through nasal prongs or a tube placed through the nose, called continuous positive airway pressure
(CPAP). Infants with more severe RDS may need the help of a ventilator to breathe. A ventilator is a mechanical device that forces air in and out of the lungs through a tube passed through the nose or mouth and into the windpipe (trachea). This treatment must be closely monitored because the pressure on the lungs can cause more damage. Too much oxygen can also damage the retina and cause vision problems. Your doctor will continue to monitor your baby’s blood oxygen level so he or she can be given only as much oxygen as necessary and can be weaned of the breathing assistance as soon as possible. Severe cases are also treated with a drug that is close to the natural surfacant found in the lungs. This drug is dripped into the lungs through a very thin tube in the baby’s trachea. This treatment reduces the risk of lung rupture and within a few days the infant is usually breathing more easily. Sometimes babies who are born prematurely but without signs of RDS are given the surfacant drug as a preventive measure. If your child has a collapsed lung
(pneumothorax), air has leaked into the chest cavity and needs to be removed right away. Your doctor will remove the air from the chest using a syringe and needle. A tube is then placed in the chest to stop air from accumulating. Infants who respond to treatment for RDS generally recover with no lasting effects. However, if the condition is not treated, lack of oxygen will damage the body’s major organs and they will no longer function, resulting in death.
Self-care tips
If you are pregnant and have known risk factors for premature birth, your doctor can track your baby’s lung development and be prepared to treat you and your infant accordingly. In any pregnancy, good prenatal care is essential to a healthy baby and to identify problems as soon as possible.
This information has been designed as a comprehensive and quick reference
guide written by our health care reviewers. The health information written
by our authors is intended to be a supplement to the care provided by your
physician. It is not intended nor implied to be a substitute for
professional medical advice.
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