Neonatal Respiratory Distress Syndrome
Neonatal respiratory distress syndrome (NRDS), or neonatal RDS, may occur if the lungs of the baby aren’t fully developed. It typically occurs in premature babies. Infants with neonatal RDS have difficulty breathing normally. It is also known as Hyaline membrane disease.
A full-term pregnancy lasts 40 weeks. This gives the fetus time to grow. At 40 weeks, the organs are usually fully developed. If a baby is born to early, the lungs may not be fully developed, and they may not function properly. Healthy lungs are crucial for overall health.
Sign & Symptoms –
Babies who have such problem show these signs –
• Fast breathing very soon after birth
• Grunting “ugh” sound with each breath
• Flaring (widening) of the nostrils with each breath
• Chest retractions. Skin over the breastbone and ribs pulls in during breathing
• Changes in color of lips, fingers and toes
• Reduced urine output
Causes –
Neonatal RDS occurs in infants whose lungs have not yet fully developed. The earlier the in fant is born, the more likely it is for the baby to have RDS and to need extra oxygen and help breathing.
The disease is mainly caused by a lack of slippery substance in the lungs called surfactant. This substance helps the lungs fill with air and keeps the air sacs from deflating. Surfactant is a liquid made in the lungs at about 26 weeks of pregnancy. As the fetus grows, the lungs make more surfactant.
Surfactant coats the tiny air sacs in the lungs and helps to keep them from collapsing. The air sacs must be open to allow oxygen to enter the blood from the lungs and carbon dioxide to be released from the blood into the lungs.
Neonatal RDS can also be due to genetic problems with lung development.
Most cases of RDS occur in babies born before 37 to 39 weeks. The more premature the baby is, the higher the chance of NRDS after birth. The problem is uncommon in babies born full-term (after 39 weeks).
Risk Factors –
Those at greater risk are –
• Siblings with RDS infection
• Mother has diabetes
• C-section delivery
• Twin or multiple births
• Baby is sick at the time of delivery
• Infection
• Cold, stress or hypothermia. Baby cannot keep body temperature warm at birth
Complications –
Neonatal RDS may get worse over the first few days of a baby’s life. RDS can be fatal. There may also be long-term complications due to either receiving too much oxygen or because organs lacked oxygen. Complications can include –
• Air buildup in the sac around the heart, or around the lungs
• Bleeding into the brain or lungs
• Bronchopulmonary dysplasia
• Intellectual disabilities
• Blindness
• Blood clots
• Blood infection
• Collapsed lung (pneumothorax)
• Kidney failure (in severe RDS)
Diagnosis –
If a doctor suspects RDS, they will order lab tests such as blood tests to rule out infections that could cause breathing problems.
They’ll also order a chest X-ray to examine the lungs.
A blood gas analysis will check oxygen levels in the blood.
Cultures of blood and sometimes of cerebrospinal fluid.
Treatment –
To help prevent respiratory distress syndrome, doctors can give steroid medicines to pregnant women who are likely to deliver their babies early (before 37 weeks of gestation). Steroids help the baby’s lungs mature and make more surfactant before the baby is born.
When an infant is born with RDS and symptoms are immediately apparent, the infant is usually admitted to a neonatal intensive care unit (NICU).
• Oxygen
Babies with RDS need extra oxygen. It may be given in several ways –
* Nasal cannula. A small tube with prongs is placed in the nostrils.
* CPAP (Continuous Positive Airway Pressure). This machine gently pushes air or oxygen into the lungs to keep the air sacs open.
* Ventilator for severe RDS. This is a machine that helps the infant breathe when they cannot breathe well enough without help.
• Surfactant
Surfactant can be given into the baby’s lungs to replace what they do not have. This is given directly down the breathing tube that was placed in the windpipe
• IV (Intravenous) catheter treatments
A very small tube called a catheter, is placed into one or two of the blood vessels in the umbilical cord. This is how the infant gets IV fluids, nutrition and medicines. It is also used to take blood samples.
• Medicines
Sometimes antibiotics are given if an infection is suspected. Calming medicines may be given to help ease pain during treatment.
The road to recovery is different for each infant. Often neonatal respiratory distress syndrome (NRDS) gets worse befor it gets better.
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