Infant respiratory distress syndrome (RDS), sometimes referred to as neonatal RDS, is most common in babies born prematurely.

When babies are born prematurely, their lungs may not be fully developed, making breathing difficult. Without treatment, this can cause short- and long-term complications. These may include permanent lung damage, neurological delays, and death.

Below, we describe the symptoms, causes, and treatments of RDS in infants.

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RDS develops in approximately 24,000 infants in the United States annually. It is more common in babies born prematurely, whose lungs have not fully developed.

Infant RDS causes trouble breathing. The signs of this tend to present immediately after birth or within a few minutes.

Infant RDS tends to affect babies whose lungs have not fully developed before birth.

The lungs may have too little surfactant, a liquid coating that develops at about 20 weeks of gestation. As the fetus continues to grow, the lungs produce more surfactant.

This liquid coats the tiny sacs of air in the lungs, preventing them from collapsing. The air sacs must remain open for oxygen to enter the blood and for the blood to release carbon dioxide into the lungs.

A lack of surfactant can cause an infant’s lungs to collapse, leading to difficulty breathing.

Infants born with RDS have symptoms immediately after delivery or within minutes. Some common symptoms of infant RDS include:

  • a high respiratory rate, also called tachypnea
  • flaring nostrils
  • chest retractions, which may look as if the belly is pulling in beneath the ribs or breastbone
  • grunting
  • other unusual noises while breathing

It is worth noting that while RDS is more common in infants born prematurely, it can develop in any infant.

Some risk factors for infant RDS include:

  • being white
  • being male
  • having maternal diabetes
  • a lack of oxygen reaching the baby during labor and delivery
  • having restricted blood flow and oxygen
  • having a delivery in the absence of labor
  • having a low birth weight

Healthcare professionals use these tests to diagnose RDS in infants:

  • Arterial blood gas analysis. This can show whether oxygen levels in the blood are low and other related factors.
  • Chest radiography. This can show how the lungs have formed.
  • Various laboratory tests. These can rule out an infection and other possible causes of difficulty breathing.

RDS treatment usually begins with moving the infant to the neonatal intensive care unit, or NICU, where they receive continuous supervision and medical attention from specialists.

The National Institutes of Health (NIH) list these specific treatment techniques:

  • Surfactant replacement therapy. Infants with RDS may receive this until their lungs produce enough surfactant on their own.
  • Ventilator or nasal continuous positive airway pressure support. A machine provides breathing support until the lungs make enough surfactant.
  • Fluids and nutrients. These help the infant’s lungs develop.
  • Liquid intake checks. This is to make sure that fluid does not accumulate in the lungs.

If diagnosis and treatment take place shortly after birth, the outlook for infants with RDS is good. Studies show a mortality rate of 2–10% in developed countries when treatment begins right away.

RDS can cause long-term complications, such as:

  • damage to lung tissue, also called bronchopulmonary dysplasia
  • decreased clearance of fluid from the lung fluids
  • lung injury and inflammation
  • immature or irregular development of blood vessels, particularly in or around the lungs
  • neurodevelopmental delays

Without treatment, RDS can cause a severe lack of oxygen in the blood during the first few days of life. This can result in multiple organ failure and death.

If an infant receives immediate treatment, their lungs continue to develop and produce enough surfactant. In this case, after about 4–5 days, RDS usually resolves. These infants tend to need follow-up care but go on to live healthy, regular lives.

The best way to prevent infant RDS is to prevent premature birth, which takes place between 20 and 37 weeks of gestational age.

Some strategies to prevent preterm birth include:

  • progesterone supplementation, for people with short cervixes
  • avoiding smoking during pregnancy
  • avoiding alcohol during pregnancy
  • avoiding recreational drugs during pregnancy

Infant RDS tends to develop in babies born prematurely, before their lungs have fully developed and have a liquid coating called surfactant. Without surfactant, the lungs can collapse, causing difficulty breathing.

Most symptoms of RDS develop immediately after birth. If treatment begins right away, the outlook is good4–5 days.