Neonatal respiratory distress syndrome

Introduction
Neonatal respiratory distress syndrome (NRDS) happens when a newborn baby's lungs aren't fully
developed and they cannot provide enough oxygen. It usually affects premature babies.
NRDS is also known as:

hyaline membrane disease

infant respiratory distress syndrome
newborn respiratory distress syndrome
surfactant deficiency lung disease (SDLD)

Despite having a similar name, acute respiratory distress syndrome (ARDS) isn't related. ARDS is caused by a
serious underlying health condition and can affect people of any age.

Why it happens
NRDS most often occurs when there isn't enough surfactant in the lungs. This substance, made up of proteins and
fats, helps keep the lungs inflated and prevents parts of the lung called air sacs collapsing.
A baby normally begins producing surfactant sometime between weeks 24 and 28 of pregnancy. Most babies
produce enough surfactant to breathe normally by week 34. If your baby is born prematurely, they may not have
enough surfactant in their lungs.
Occasionally, NRDS occurs in babies that aren't born prematurely. This is usually due to other risk factors, such
as:

the mother having diabetes

the baby being underweight
poor lung development, which can be caused by a variety of illnesses

Problems with the genes can play a role in lung development, but this is very rare.

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It's estimated that half of all babies born before 28 weeks of pregnancy will develop NRDS. However, this has
reduced in recent years, as steroid injections can be given to mothers at risk of NRDS during premature labour.

Signs and symptoms

The signs of NRDS are often noticeable immediately after birth and get worse over the following few days. They
can include:

blue-coloured lips, fingers and toes

rapid, shallow breathing
flaring nostrils
a grunting sound when breathing

As premature babies are usually born in hospital, most babies with NRDS are already in hospital when they
develop these problems and receive treatment (see below).
If you give birth outside hospital and notice the above symptoms in your child, call 999 immediately and ask for an
ambulance.

Diagnosing NRDS
A number of tests can be used to look for the signs of NRDS and rule out other possible causes.
These tests may include:

a physical examination
blood tests to measure the amount of oxygen in the blood and check for an infection
a pulse oximetry test to measure how much oxygen is being absorbed in the blood, using a sensor
attached to the fingertip, ear or toe
a chest X-ray to look for the distinctive cloudy appearance of NRDS

Treating NRDS
Most babies with NRDS need breathing help with extra oxygen and possibly some form of ventilator support.
Babies needing ventilation can often be treated with a medication directly into the lungs called artificial surfactant,
which helps to restore normal lung function.

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Some cases can be prevented or at least made less severe by treating the mother with a medication called
betamethasone before birth.
Read more about treating NRDS.

Complications
In the majority of cases, NRDS can be successfully treated and deaths directly linked to NRDS are rare in the UK.
However, in more severe cases, there's a risk of further problems. These can include scarring to the lungs,
leading to longer-term breathing problems. There's also a risk of brain damage, which may result in problems
such as learning difficulties.
Read more about the possible complications of NRDS.

Treating neonatal respiratory distress syndrome

Treatment of neonatal respiratory distress syndrome (NRDS) aims to support the baby's breathing
while treating the underlying cause.

Treatment before birth

If you're thought to be at a risk of giving birth before week 34 of pregnancy, treatment for NRDS can begin before
birth. You'll usually be given two injections a day of a steroid medication called betamethasone, starting a few
days before the delivery is expected.
Betamethasone helps stimulate the development of the babys lungs. It's estimated that the use of betamethasone
prevents NRDS occurring in a third of premature births.

Treatment after the birth

If betamethasone isn't used, or if it's unsuccessful in preventing NRDS, it's likely that your baby will be transferred
to a neonatal unit.

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You baby may only need extra oxygen if the symptoms are mild; it's usually given into an incubator or by nasal
tubes. If symptoms are more severe, your baby will be attached to a machine to either support or take over their
breathing. These treatments are often started immediately in the delivery room before transfer to the neonatal unit.
Your baby may also be given a dose of artificial surfactant, usually delivered through a breathing tube.
Evidence suggests that early treatment (within two hours of delivery) is more beneficial than if treatment
is delayed.
Your baby will also be given fluids and nutrients through a tube connected to one of their veins.
Some babies with NRDS only require help with breathing for a few days, although others usually those born
extremely prematurely may need support for weeks or even months.
Premature babies often have multiple problems that keep them in hospital, but generally they're well enough to go
home around their original expected delivery date. However, the exact length of time your baby needs to stay in
hospital largely depends on how early they were born.

Complications of neonatal respiratory distress syndrome

Babies who experience neonatal respiratory distress syndrome (NRDS) have a significant risk of
developing further problems.

Air leaks
In some cases of NRDS, air can leak out of the lungs and become trapped in the chest cavity. This is known as
pneumothorax.
The pocket of air places extra pressure on the lungs, causing them to collapse and leading to additional breathing
problems.
Air leaks can be treated by inserting a tube into the chest to allow the trapped air to drain.

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Internal bleeding
Babies with NRDS may experience bleeding inside their lungs (pulmonary haemorrhage) and brain (cerebral
haemorrhage).
Bleeding into the lungs can be difficult to treat, but usually air pressure from a ventilator and transfusion of blood
products allows the bleeding to stop.
Bleeding into the brain is quite common in premature babies, but fortunately most bleeds are mild and there are
few longer-term problems. Larger bleeds occasionally require surgery to drain accumulating fluid.

Bronchopulmonary dysplasia
Bronchopulmonary dysplasia (BPD) is a long-term lung condition that can affect some children with NRDS. It
develops when the ventilator used to treat NRDS causes scarring to the lungs, which affects their development.
Symptoms of BPD include, rapid, shallow breathing and shortness of breath.
Babies with severe BPD usually require additional oxygen, through tubes into their nose, to help with their
breathing. This is usually stopped after a few months, when the lungs have healed.
However, children with BPD may require regular medication, such as bronchodilators, to help widen the airways
of their lungs and assist with their breathing.

Developmental disabilities
If the brain is damaged during NRDS, either due to bleeding or a lack of oxygen, it can lead to long-term
developmental disabilities, such as learning difficulties, movement problems, impaired hearing and impaired
vision.
However, these developmental problems are not usually severe. For example, one survey estimated that three out
of four children with developmental problems only have a mild disability, which shouldn't stop them leading a
normal adult life.

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NHS Choices has been developed to help you make choices about your health, from lifestyle decisions about
things like smoking, drinking and exercise, through to the practical aspects of finding and using NHS services
when you need them.
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NHS Choices puts you in control of your healthcare

NHS Choices has been developed to help you make choices about your health, from lifestyle decisions about
things like smoking, drinking and exercise, through to the practical aspects of finding and using NHS services
when you need them.
www.nhs.uk