Manage Your Child’s Care with MyChart
If a baby is born before his lungs have matured, he will develop
respiratory distress syndrome (RDS). A baby with RDS tries to cry
and breathe at birth, but within minutes to hours he starts
working hard to breathe because his lungs tend to collapse with
A baby with RDS:
Two other possible causes of breathing problems in babies are
infection in the lungs (pneumonia) and extra fluid in the lungs.
Before birth a baby does not use his lungs because the placenta
delivers oxygen from the mother to the baby's bloodstream. Once
the baby is born, the baby's lungs fill with air and begin
delivering oxygen to the blood. To prepare the lungs to work
properly after birth, a baby produces a substance called
Surfactant is a material that lines the air sacs of the lungs and
helps keep the lungs open when breathing out. Babies usually start
making surfactant sometime between the 30th and 36th weeks of the
pregnancy. Nearly all babies have made surfactant by the 35th week
of pregnancy. Certain events, such as the mother's water breaking
early or preterm labor, may cause a baby to start making
surfactant early. Without surfactant, the lungs tend to collapse
with each breath. A lack of surfactant causes RDS.
Certain laboratory tests are done to help determine the cause of
the breathing problems. These tests include:
Many babies develop RDS. Usually the babies who have RDS are more
than 6 weeks premature, but occasionally more mature babies have
RDS. There are many effective treatments for babies with RDS, and
most infants recover completely within the first weeks of life.
A baby who has breathing difficulties is placed on a warming
bed in the special care nursery (SCN). He is attached to a
monitor that continuously measures his heart rate and
respiratory (breathing) rate. This monitor is called a
cardiorespiratory monitor. The baby is also attached to a
monitor that records the amount of oxygen in his skin. It is
called a pulse oximeter.
A baby with RDS breathes fast and uses all of his energy to
breathe. He does not have any energy left for eating and
cannot coordinate sucking with the fast breathing rate. An
intravenous (IV) line is inserted into the veins of the baby's
hands, feet, or scalp. The IV provides fluid to prevent
dehydration and gives the baby sugar for energy. The baby will
be able to take milk after the lungs have improved.
A baby with RDS needs extra oxygen to keep the level of oxygen
in his blood in the normal range. If tests show that a baby
needs extra oxygen, he is placed in a plastic hood into which
extra oxygen is blown. The level of oxygen a baby breathes is
called FiO2. The level of oxygen in the blood is called pO2.
If a baby needs more than 40 percent oxygen or a ventilator to
breathe, the blood gases are checked frequently. So the baby
does not have to be stuck with a needle each time a sample of
blood is needed, an IV line may be inserted into an artery.
The IV is often placed in the artery in the umbilical cord and
passed into the aorta, the largest artery in the body. This
umbilical artery catheter allows blood to be taken painlessly
from the baby. The catheter can also be used to give fluids
and medications to the baby. Arteries in the hands and feet
may also be used for the IV.
If the work of breathing becomes too difficult for the baby,
he will begin to tire. There are two ways to help his
breathing: nasal CPAP and a ventilator.
Nasal CPAP: Nasal CPAP is a device that blows oxygen under
pressure in through the nose. It helps inflate the lungs. A
strap placed around the baby's head holds the CPAP prongs in
the nose. The baby does all the breathing but the CPAP
delivers oxygen at a pressure that keeps the lungs inflated.
Nasal CPAP is used for the bigger and stronger babies or
babies who have mild disease and need just a little help.
Ventilator: When a baby gets too tired to breathe effectively,
a ventilator may be used to give the baby extra breaths. A
tube is placed through the baby's mouth and into the windpipe
(trachea). The tube is kept in place with tape across the
baby's upper lip. The ventilator blows oxygen under pressure
through the tube and into the baby's lungs. The baby breathes
on his own, but the ventilator gives extra breaths.
Babies usually get used to the ventilator and actually feel
more comfortable because they don't have to work so hard to
breathe. Occasionally a baby may be irritated by the
ventilator. If this happens the baby may be given a mild
sedative to help him relax and sleep.
Babies who need a ventilator may be given 2 to 4 doses of
artificial surfactant during their first 24 to 48 hours of
life. If artificial surfactant is given, not as much oxygen or
pressure on the ventilator will have to be used, and the baby
will get better faster. The baby will still need the
ventilator for about 3 days and then will begin to get better
as his lungs make his own surfactant.
A baby with RDS is sick for about 3 days. In the first 3 days his
need for oxygen will increase or stay the same. When the baby
starts needing less oxygen, it is a sign that the baby is getting
better. If your baby is on a ventilator, the amount of oxygen and
breaths he is given will be reduced until he can finally breathe
on his own. At this time the breathing tube can be removed.
When the baby is able to breathe easily at a normal rate and does
not need extra oxygen, he can begin feedings. If the baby is
strong and mature enough to suck, he can begin to breast-feed or
bottle-feed. However, often a baby is weak because his lungs are
still recovering. A weak baby can be fed by passing a tube through
his mouth and into his stomach. Milk is dripped through the tube
into the baby's stomach. This is called gavage feeding. This way
the baby can be fed without using a lot of energy to suck. Soon he
will be able to breast- or bottle-feed vigorously.
All babies can go 4 or more days on IV fluids without eating and
be perfectly fine. Don't worry if your baby can't eat at first and
loses weight. Once he is well, he will make up for lost time. Even
a healthy baby who eats immediately after birth loses weight in
the first week of life.
Most babies recover completely from RDS with no short-or long-term
problems. The most common complication occurring shortly after
birth is a pneumothorax. Long-term problems, such as chronic lung
problems or neurologic problems (brain damage), are usually
related to how premature the baby is rather than to the RDS.
Sometimes the air sacs of a baby's lungs tear. The air that
should be inside the air sacs escapes outside the lungs but
remains inside the chest. The accumulated air then presses on
the lung and makes it even more difficult for the baby to
breathe. This is called an air leak, or pneumothorax. A
pneumothorax may occur at any time with no apparent cause, or
it may happen when the baby is receiving oxygen under pressure
(on CPAP or a ventilator).
A small pneumothorax does not require treatment. A larger one
is treated by drawing the air out through a needle. For the
largest or most persistent air leaks, a tube is inserted into
the chest and the air is drained out continuously. Over time
(hours to days), the air sacs heal themselves and the tube can
Babies who have unusually severe lung disease or are very
premature may require a lot of oxygen and pressure from the
ventilator to survive. This can scar the lungs. Some of these
babies may need to be on the ventilator for several weeks and
may need oxygen for several months. These babies may be given
diuretics to get rid of extra water in the lungs.
Most babies outgrow these problems in the first few months.
They grow new lung tissue, which replaces the scarred lung
tissue. However, during the first few years of life they may
have more bouts of wheezing and may get pneumonia when they
have upper respiratory infections (colds). These problems will
occur less often as the children grow older.
Virtually all babies who have respiratory distress syndrome grow
up to be healthy, normal children. RDS does not cause brain damage
or long-term developmental problems.
If the doctor knows that the baby is going to be premature, drugs
can be given to the mother to help the baby start producing
surfactant before birth. The most frequently used drug is
By testing the amniotic fluid, doctor's can check if a baby has
made surfactant. Amniotic fluid is collected by doing a procedure
called an amniocentesis. The fluid can also be sampled right after
the mother's water breaks. If the baby has not yet made
surfactant, the mother may be given betamethasone and may also be
given other drugs to try to stop labor and delay the birth.