What is missing from the lungs of newborn babies with infant respiratory distress syndrome?

Respiratory distress syndrome (RDS) is a breathing problem that affects newborns, mostly those who are born more than 6 weeks early. The earlier or more premature a baby is born, the more likely the baby will develop RDS.

Many babies with milder symptoms get better in 3–4 days. Those who are very premature may take longer to recover.

What Are the Signs & Symptoms of Respiratory Distress Syndrome?

Within minutes or hours of being born, a baby with RDS will have breathing problems. If untreated, these problems get worse over time.

Symptoms of RDS include:

• fast breathing
• noisy breathing or grunting
• retractions (a tugging in of the muscles between the ribs, under the ribcage, and at the neck) while trying to breathe
• a blue tint in the lips, nail beds, and skin from lack of oxygen, called

What Happens in Respiratory Distress Syndrome?

RDS happens when a baby's lungs don't make enough of a fatty substance called surfactant (ser-FAK-tent).

Surfactant is made in the last few weeks of pregnancy. It helps tiny air sacs in the lungs called alveoli (al-VEE-oh-lye) open more easily. These sacs fill with air when a baby breathes after birth. Surfactant also helps keep the alveoli open when air leaves the lungs.

When a baby with RDS tries to breathe:

• many of the alveoli cave in and can't open
• oxygen can't get to the blood
• carbon dioxide can't leave the body

If untreated, in time this can damage a baby's brain and other vital organs.

How Is Respiratory Distress Syndrome Diagnosed?

Health care providers will suspect RDS in a premature baby who has trouble breathing and needs oxygen soon after birth. A chest X-ray of the lungs can confirm the diagnosis.

How Is Respiratory Distress Syndrome Treated?

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.

Doctors will give oxygen to a baby who has signs of RDS and breathing trouble. If breathing problems continue, the baby may need continuous positive airway pressure (CPAP). With CPAP:

• The baby wears a mask or a  that's connected to a machine.
• The machine sends a stream of air or oxygen into the lungs through the nose.

CPAP opens the alveoli, supplies oxygen, and prevents the alveoli from collapsing. A baby who continues to have signs of respiratory distress or trouble maintaining a good oxygen level may need more support with a breathing machine or ventilator.

Babies with RDS may need treatment with surfactant. Doctors give surfactant through a breathing tube right into the lungs.

Babies with RDS get treatment in a neonatal intensive care unit (NICU). There, a team of experts cares for these newborns, including:

• doctors who specialize in newborn care (neonatologists)
• skilled nurses and neonatal nurse practitioners
• respiratory therapists, who help with breathing machines

Many babies start to get better within 3 to 4 days, as their lungs start to make surfactant on their own. They'll start to breathe easier, look comfortable, need less oxygen, and can be weaned from the support of CPAP or a ventilator. Some babies — especially very premature babies — need longer treatment until they can breathe on their own.

What Else Should I Know?

Respiratory support with oxygen and a ventilator helps newborn babies with respiratory distress. But long-term use can damage a premature baby's lungs. Some babies born very early need oxygen support for a long time, leading to a condition called bronchopulmonary dysplasia (BPD).

Respiratory distress syndrome (RDS) is a common problem in premature babies. It causes babies to need extra oxygen and help with breathing. The course of illness with RDS depends on:

• The size and gestational age of your baby

• How serious the illness is

• Whether your baby has an infection

• Whether your baby has a heart defect called patent ductus arteriosus

• Whether your baby needs a machine to help him or her breathe (ventilator)

RDS typically gets worse over the first 2 to 3 days. It then gets better with treatment.

What causes RDS in premature babies?

RDS occurs when there is not enough surfactant in the lungs. Surfactant is a liquid made by the lungs that keeps the airways (alveoli) open. This liquid makes it possible for babies to breathe in air after delivery. An unborn baby starts to make surfactant at about 26 weeks of pregnancy. If a baby is premature (born before 37 weeks of pregnancy), he or she may not have made enough surfactant yet.

When there is not enough surfactant, the tiny alveoli collapse with each breath. As the alveoli collapse, damaged cells collect in the airways. They further affect breathing. The baby has to work harder and harder to breathe trying to reinflate the collapsed airways.

As the baby's lung function gets worse, the baby takes in less oxygen. More carbon dioxide builds up in the blood. This can lead to increased acid in the blood (acidosis). This condition can affect other body organs. Without treatment, the baby becomes exhausted trying to breathe and over time gives up. A ventilator must do the work of breathing instead.

Which premature babies are at risk for RDS?

RDS occurs most often in babies born before the 28th week of pregnancy. Some premature babies get RDS severe enough to need a breathing machine (ventilator). The more premature the baby, the higher the risk and the more severe the RDS.

Most babies with RDS are premature. But other things can raise the risk of getting the disease. These include:

• The baby is a boy or is white

• The baby has a sibling born with RDS

• C-section (Cesarean) delivery, especially without labor. Going through labor helps babies' lungs become ready to breathe air.

• The baby doesn’t get enough oxygen just before, during, or after birth (perinatal asphyxia)

• The baby has trouble maintaining body temperature (cold stress)

• Infection

• The baby is a twin or other multiple (multiple birth babies are often premature)

• The mother has diabetes (a baby with too much insulin in his or her body can delay making surfactant)

• The baby has a condition called patent ductus arteriosus (PDA)

What are the symptoms of RDS in premature babies?

These are the most common symptoms of RDS:

• Breathing problems at birth that get worse

• Blue skin color (cyanosis)

• Flaring nostrils

• Rapid breathing

• Grunting sounds with breathing

• Ribs and breastbone pulling in when the baby breathes (chest retractions)

The symptoms of RDS usually get worse by the third day. When a baby gets better, he or she needs less oxygen and mechanical help to breathe.

The symptoms of RDS may look like other health conditions.

How is RDS in premature babies diagnosed?

RDS is usually diagnosed by a combination of these:

• Baby’s appearance, color, and breathing efforts. These can point to a baby's need for help with breathing.

• Chest X-rays of the lungs. X-rays make images of bones and organs.

• Blood gas tests. These measure the amount of oxygen, carbon dioxide and acid in the blood. They may show low oxygen and higher amounts of carbon dioxide.

• Echocardiography. This test is a type of ultrasound that looks at the structure of the heart and how it is working. The test is sometimes used to rule out heart problems that might cause symptoms similar to RDS. It will also show whether a PDA may be making the problem worse.

How is RDS in premature babies treated?

Treatment will depend on your child’s symptoms, age, and general health. It will also depend on how severe the condition is.

Treatment for RDS may include:

• Placing a breathing tube into your baby's windpipe (trachea)

• Having a ventilator breathe for the baby

• Extra oxygen (supplemental oxygen)

• Continuous positive airway pressure (CPAP). This is a breathing machine that pushes a continuous flow of air or oxygen to the airways. It helps keep tiny air passages in the lungs open.

• Artificial surfactant. This helps the most if it is started in the first 6 hours of birth. Surfactant replacement may help make RDS less serious. It is given as preventive treatment for some babies at very high risk for RDS. For others who become sick after birth, it is used as a rescue method. Surfactant is a liquid given through the breathing tube.

• Medicines to help calm the baby and ease pain during treatment

What are possible complications of RDS in premature babies?

Babies sometimes have complications from RDS treatment. As with any disease, more severe cases often have greater risks for complications. Some complications of RDS include:

• Lungs leak air into the chest, the sac around the heart, or elsewhere in the chest

• Chronic lung disease (bronchopulmonary dysplasia)

How can RDS in premature babies be prevented?

Preventing a premature birth is the main way to prevent RDS. When a premature birth can’t be prevented, you may be given corticosteroids before delivery. These medicines may greatly lower the risk and severity of RDS in the baby. These steroids are often given between 24 and 34 weeks of pregnancy to women at risk of early delivery. They may sometimes be given up to 37 weeks. But if the delivery is very quick or unexpected, there may not be time to give the steroids. Or they may not have a chance to start working.   

Key points about RDS in premature babies

Respiratory distress syndrome (RDS) is a common problem in premature babies. It can cause babies to need extra oxygen and help with breathing.

RDS occurs most often in babies born before the 28th week of pregnancy and can be a problem for babies born before 37 weeks of pregnancy.

RDS typically gets worse over the first 2 to 3 days. It then gets better with treatment.

Treatment may include extra oxygen, surfactant replacement, and medicines.

Preventing a premature birth is the main way to prevent RDS.

Next steps

Tips to help you get the most from a visit to your child’s healthcare provider:

• Know the reason for the visit and what you want to happen.

• Before your visit, write down questions you want answered.

• At the visit, write down the name of a new diagnosis, and any new medicines, treatments, or tests. Also write down any new instructions your provider gives you for your child.

• Know why a new medicine or treatment is prescribed and how it will help your child. Also know what the side effects are.

• Ask if your child’s condition can be treated in other ways.

• Know why a test or procedure is recommended and what the results could mean.

• Know what to expect if your child does not take the medicine or have the test or procedure.

• If your child has a follow-up appointment, write down the date, time, and purpose for that visit.

• Know how you can contact your child’s provider after office hours. This is important if your child becomes ill and you have questions or need advice.

  What is missing from the lungs of a newborn babies with infant respiratory distress syndrome quizlet?

  Respiratory distress syndrome is a breathing disorder that mainly occurs in premature newborns. This is due to the fact that premature infants have immature lungs that aren't able to produce enough surfactant, which coats the insides of the lungs to keep them from collapsing.

  What is missing in infant respiratory distress syndrome bronchioles pleura one or more lobes of the lung alveoli surfactant?

  Infant respiratory distress syndrome is caused by the absence of a natural lung wetting agent (surfactant) in the immature lungs of infants. Since surfactant normally develops late in prenatal life it usually is not present in the very premature infant of about 26-36 weeks of gestational age.

  What key element is missing from a premature infant that predisposes them to respiratory difficulties?

  Babies born without enough surfactant are said to have respiratory distress syndrome or RDS. Sometimes a premature birth is not a completely unexpected event.

  Which of the following deficiencies result in respiratory distress syndrome?

  Neonatal respiratory distress syndrome (RDS) occurs from a deficiency of surfactant, due to either inadequate surfactant production, or surfactant inactivation in the context of immature lungs. Prematurity affects both these factors, thereby directly contributing to RDS.