Respiratory distress syndrome is when a baby’s lungs have not developed properly. This means the lungs cannot provide enough oxygen, which causes breathing difficulties.
In babies with RDS, their lungs do not have enough surfactant, a liquid made up of proteins and fats that helps to keep the lungs inflated. This means the lungs can’t expand normally, which leads to breathing difficulties.
It usually affects premature babies whose lungs had not fully developed before birth, but it can happen to babies born at term because of other medical conditions, such as the mother/birthing parent having diabetes during pregnancy.
If doctors suspect that your baby will be born premature, they may offer you a course of steroid injections to reduce the risk of your baby developing RDS after they are born. The steroids can stimulate the development of your baby’s lungs.
What are the signs of RDS?
The signs of RDS usually appear in the first four hours after birth.
These signs include:
- rapid or shallow breathing
- flaring of the nostrils
- noisy breathing or grunting
- blue fingers, toes or lips. On Black, brown or darker skin tones this may be easier to see on lips, tongues and gums, under nails, around your baby’s eyes, on the palms of the hands and on the soles of the feet
What tests might my baby have for RDS?
Your baby is likely to have one or more of the following tests:
Chest X-ray: This is used to check your baby’s lungs and can help to diagnose RDS
Pulse oximetry: This measures how much oxygen is in your baby’s blood (also called blood oxygen saturation) with a sensor placed on their finger, ear or toe
Heart rate monitoring and breathing tests: These are measured using sensors that are placed on your baby’s skin
Blood gas test: This is a blood test which measures your baby’s levels of oxygen, carbon dioxide and acid in the blood. Doctors will take blood from a heel prick sample. It can also be taken from a plastic tube that is placed in your baby’s tummy button, hand or foot
The treatment that your baby will need will depend on how early they are born and how severe their symptoms are. If you have questions or are unsure about any part of your baby’s treatment or care, speak to their healthcare team.
Here are some of the treatments that your baby may be offered:
Surfactant therapy
Your baby may be given surfactant therapy to replace the low levels of surfactant in their lungs, the liquid of proteins and fats that helps to keep the lungs inflated. This is usually needed for a short time in the first 2–3 days after birth.
Surfactant can be given using an endotracheal tube, which is a plastic tube that connects your baby to the ventilator. This tube goes through your baby’s mouth into their trachea (windpipe).
Breathing (respiratory) support: oxygen and CPAP
Some babies will need breathing support with oxygen therapy to help improve the low levels of oxygen in their blood. There are different ways of providing breathing support to babies:
Conventional oxygen therapy
High-flow nasal oxygen therapy (including Optiflow and Vapotherm), where a warmed mix of oxygen and air is given
In these cases, oxygen is usually given through nasal cannulas, which are small soft tubes that are placed in your baby’s nostrils.
Continuous positive airway pressure (often shortened to CPAP) is another type of respiratory support. It passes air with or without oxygen (depending on what your baby needs) through two thin tubes in your baby’s nose, or through a small mask that fits over their nose. CPAP slightly raises the pressure of the air and oxygen given, which helps keep your baby’s lungs inflated. This makes it easier for them to breathe.
During oxygen support and CPAP, your baby breathes on their own.
Mechanical ventilation
Your baby will usually continue to breathe for themselves, but if they are unable to, a breathing machine (ventilator) can take over or assist with their breathing. They blow air, with or without oxygen (depending on what your baby needs), into your baby’s lungs. This is done through a tube that is passed through your baby’s nose or mouth (called an endotracheal tube) into their trachea (windpipe).
Medication
apnoea of prematurity (pauses in breathing) and chronic lung disease (CLD).
Feeding (nutritional) support
To ensure that your baby continues to grow and develop, they may be fed through a tube passed into their nose or mouth to their stomach. This is called tube feeding. The mother or birthing parents' breast milk provides the best nutrition for their baby, but formula or donor milk will be provided if expressing breast milk is not possible.
Some babies may also need to be fed using nutrition that is given in a liquid form directly into their bloodstream intravenously (into a vein). This is called parenteral nutrition (PN).
If your baby has RDS, you may have questions about how it will affect them in the short- and long-term.
In the short-term, some babies with RDS can develop a pneumothorax, which happens when air leaks out of the lung. Asthma + Lung UK has some more information about pneumothorax in babies and children, including how it is treated and how long it can take to recover.
Some premature babies with RDS may later be diagnosed with chronic lung disease (CLD). In babies born premature, where their lungs are more immature, treatment for RDS can cause scarring and changes to the development and growth of the lungs. This can lead to CLD.
Doctors may suspect CLD in your baby if they need to remain on oxygen, CPAP or a ventilator when they are at 36 weeks gestation (corrected age). We have more information about CLD, treatment and long-term effects.
Having a baby who is unwell with a respiratory condition, such as RDS, can be a stressful experience.
How you feel and process what has happened to you and your baby might be different to others who face these challenges. We have some information about how you might be feeling and the different types of support available.
