Respiratory Distress Syndrome

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What is Respiratory Distress Syndrome?

Respiratory Distress Syndrome (RDS) is the most common lung disease of premature infants. RDS occurs in babies with incomplete lung development. The more premature the infant, the greater likelihood of RDS. RDS is due to insufficient surfactant in the lungs. Surfactant is a material normally produced by the lung that spreads like a film over the tiny air sacs allowing them to stay open. Open air sacs are essential for oxygen to enter the blood from the lung and for carbon dioxide to be released from the blood into the lung for exhalation.

What does a baby with Respiratory Distress Syndrome look like?

The baby will have difficulty breathing. They will have:

  • Rapid breathing
  • Pulling in of the ribs and center of the chest with each breath, called retractions.
  • An "ugh" sound with each breath, called grunting.
  • Widening of the nostrils with each breath, called flaring.

How is RDS treated?

Your baby will need extra oxygen. Room air is 21% oxygen. Your baby needs higher oxygen to stay pink. The added oxygen might be given by placing a plastic hood over the baby's head.

Your baby may need CPAP (Continuous Positive Airway Pressure). This is oxygen delivered under a small amount of pressure usually through little tubes that fit into the nostrils of the nose. Delivering oxygen under pressure helps keep the air sacs open.

If the RDS is moderate or severe, your baby may need to have a breathing tube inserted into his/her wind pipe. This is necessary if your baby needs help with breathing or if your baby is to receive surfactant as a medication. Inserting the tube is called intubation. Once intubated, your baby may be placed on a breathing machine (respirator or ventilator) to help him/her breathe.

Your baby may be given surfactant, a drug which replaces the substance that your baby's lungs lack. This is given directly down the breathing tube. A baby must be intubated to receive surfactant.

Your baby may have an umbilical arterial catheter (UAC) and/or an umbilical venous catheter (UVC) placed. This consists of placing a very small piece of tubing (catheter) into one or two of the blood vessels in the baby's umbilical cord stump. These catheters are used to:

  • give the infant needed fluids intravenously (by vein).
  • give the infant medications.
  • give the infant nutrients.
  • obtain blood samples from your baby without sticking him/her.

Frequent blood sampling is necessary to:

  • determine if the baby is receiving the right amount of oxygen, sugar water and other things to keep the body in balance.
  • determine the correct settings (oxygen, respiratory rate, etc.) on the breathing machine to meet your baby's needs.
  • Your baby will be hooked up to one or more monitors. Wires will connect patches on your baby to the monitors.

Your baby will be in a special bed to help keep him/her warm.

How long does RDS last?

For each baby the course is different. The disease usually gets worse for about 3-4 days. Then, the baby gradually needs less added oxygen. If a baby has relatively mild disease and has not needed a breathing machine, s/he may be off oxygen in 5-7 days. If a baby has more severe disease there is also improvement after 3-5 days but the improvement may be slower and the baby may need extra oxygen and/or a ventilator for days to weeks. Recovery is slower if:

  • the baby is very tiny (<2 1/2 pounds at birth)
  • the baby's disease was severe (required high oxygen and ventilator settings in the first days)
  • the baby also had infection
  • the baby had complications such as Pneumothorax, Pulmonary Interstitial Emphysema or Patent Ductus Arteriosus

How can I tell if my baby is getting better?

  • Your baby will breathe easier. The breathing rate will decrease.
  • Your baby will need less oxygen. The goal is to get down to room air, 21%.
  • If your baby is on CPAP, the amount of CPAP will be decreased and CPAP may be stopped entirely.
  • If your baby is on a breathing machine, the doctors will gradually change the settings on the machine to decrease the amount of work from the machine and increase the amount of breathing by the baby. The amount of added oxygen will also decrease.

Are there long term problems after RDS?

Long term problems are more likely if the disease has been severe or if there have been complications. Possible problems may include:

  • increased severity of colds or other respiratory infections, especially for the first two years.
  • increased sensitivity to lung irritants such as smoke, pollution.
  • greater likelihood of wheezing or other asthma-like problems in childhood than babies without RDS.
  • greater likelihood of hospitalization in the first two years of life than babies without RDS.
  • if the RDS was severe, the baby may have injury and scaring of the lung called Bronchopulmonary Dysplasia.

Will RDS cause developmental abnormalities?

RDS does not cause abnormal development. However, babies who are sick with RDS may have other problems that are associated with abnormal development.