Acute Respiratory Distress Syndrome (ARDS)

Respiratory Distress Syndrome in Newborns
(Hyaline Membrane Disease)
Definition
Respiratory distress syndrome (RDS) occurs mainly in infants who are born prematurely. It causes newborns to have difficulty breathing. If it is not properly treated, RDS can result in complications, such as an infection of the bloodstream and bleeding into the brain. In severe cases, RDS can lead to convulsions and death.
Causes
RDS occurs in premature infants because their lungs have not developed enough. Immature lungs lack surfactant. Surfactant is a foamy fluid that is crucial for the air sacs in the lungs to expand and take in air. When there is not enough surfactant, the lungs cannot expand and the baby has a hard time breathing.
The chance of developing RDS decreases as the fetus grows. Babies born after 36 weeks rarely develop this condition.
Respiratory System of an Infant

Risk Factors
A risk factor is something that increases your chances of getting a disease or condition.
• Birth before 37 weeks; this condition is more common and more severe with greater prematurity
• Mother with insulin dependent diabetes
Symptoms
The following symptoms usually start immediately or within a few hours after birth:
• Difficulty breathing
• Rapid, shallow breathing
• Delayed or weak cry
• Grunting noise with every breath
• Flaring of the nostrils
• Frothing at the lips
• Blue color around the lips and nail beds
• Swelling of the extremities
• Decreased urine output
Diagnosis
The doctor will ask about the mother's medical history and pregnancy. The baby will also be evaluated, as outlined here:
Before Birth
Amniotic fluid may be tested for indicators of fetal lung maturity such as:
• Surfactant
• Lecithin:sphingmyelin ratio
• Phosphatidyl glycerol
After Birth
Physical Exam–includes checking the baby's breathing and looking for bluish color around the lips and nail beds
Testing for Blood Gases–to check the levels of oxygen and carbon dioxide in the blood
Chest X-ray–a test that uses radiation to take a picture of structures inside the body, in this case the chest
Treatment
Treatment for a baby with RDS usually includes oxygen and may also include:
Mechanical Respirator
A mechanical respirator (breathing machine) is used to keep the air sacs from collapsing and to improve the exchange of oxygen and other gases in the lungs. This treatment helps the baby breathe better and is almost always required in severe RDS.
Surfactant Treatment
Surfactant can be given to help the air sacs in the lungs expand and take in more oxygen. There are two options, both of which are delivered directly into the baby's windpipe. One type of surfactant comes from cows and the other is synthetic. As the surfactant takes effect, use of the respirator can gradually be reduced.
Partial Liquid Ventilation
Babies with severe RDS may need to have a special liquid put into their lungs that contains extra oxygen.
Nutrition Support
Newborns with RDS may be given food and water by the following means:
• Tube feeding–a tube is inserted through the baby's mouth and into the stomach
• Parenteral feeding–nutrients are delivered directly into a vein
Prevention
Steps to help prevent RDS can be taken at a few different times.
To reduce your chance of having a premature baby:
• Get good prenatal care beginning as early as possible in pregnancy.
• Eat a healthful diet and take vitamins suggested by your doctor.
• Do not smoke or use alcohol or drugs.
• Only take medicines that your doctor has approved.
If you are at high risk of giving birth to a premature baby:
• You may be given steroids just before delivery to help your baby's lungs develop
• Your doctor may do an amniocentesis to check the maturity of your baby's lungs and to help determine the best time for delivery
After delivery, if a premature baby has a very high chance of developing RDS, surfactant may be given right after birth to help the baby breathe better.