Respiratory Distress Syndrome of the Newborn
Summary: Respiratory distress syndrome of the newborn is also known as Infant Respiratory Distress Syndrome, Neonatal Respiratory Distress Syndrome and was once know as Hyaline Membrane Disease.

Premature babies develop a syndrome caused by insufficient surfactant production and the structure of the lungs are immature.  It can be caused by a genetic problem that causes a problem producing proteins for surfactant.

Approximately 1% of newborns suffer from it and it is the main cause of death in preemies.  As the fetus ages the incidence of RSD drops from 50% at 26-28 weeks to about 25% at 30-31 weeks.

RDS begins just before birth and the baby has rapid breathing and heart rates, irregular movements of the chest wall, grunting when exhaling, the nostrils flare and a bluish tone to the skin (cyanosis) when breathing.

The disease can cause respiratory failure with increased carbon dioxide in the blood and long episodes of apnea (breathing stops).  The course of disease lasts for two to three days even without treatment.  The first day the baby gets worse and needs a lot of support, on the second day he may be very stable and on the third day the situation is resolved.

Even though there have been major advances in the care of this problem, RDS is the leading cause of infant death in the first month of life.  Some complications of RDS is acidosis and low blood sugar, low blood pressure, changes in the lungs, and bleeding in the brain and be complicated by prematurely and under development of other organs.

On autopsy babies that die from respiratory distress syndrome exhibit a waxy material that line the alveoli (air sacs), bleeding in the lung and distension of the airways with damage to the cell lining.

I won’t go into the pathophysiology of RDS since it is very technical and difficult for some to grasp.

Can Hyaline Membrane Disease be prevented?

It can be treated and or eased if a mom about to deliver early is given one of a group of hormones glucocorticods, which can speed the production of surfactant.  If the baby is very premature it is given without checking fetal lung maturity.  If mom is more than 30 weeks pregnant the amount of surfactant can be tested by checking the level of surfactant in the amniotic fluid.

How do you treat RDS?

Oxygen is administered with a small amount of Continuous Positive Airway Pressure (CPAP) along with IV fluids to stabilize blood sugar, salts and blood pressure.  If the infant gets worse a breathing tube can be inserted in the trachea and breaths are given by a mechanical device (ventilator).

Very young preemies can be on the ventilator for a few months.  While on the machine the doctors may give the baby synthetic or animal surfactant through the breathing tube and can decrease the death rate of very small babies.  The death rate for babies over 27 weeks gestation is under 10%.

This information was found at http://en.wikipedia.org and from my 20+ years as a respiratory therapist.