Full Term Infant Respiratory Distress Syndrome Essay

1. Hillman NH, Kallapur SG, Jobe AH. Physiology of transition from intrauterine to extrauterine life. Clin Perinatol 2012; 39: 769–783. [PMC free article][PubMed]

2. Sinha SK, Donn SM. Fetal-to-neonatal maladaptation. Semin Fetal Neonatal Med 2006; 11: 166–173. [PubMed]

3. Helve O, Pitkänen O, Janér C, et al. Pulmonary fluid balance in the human newborn infant. Neonatology 2009; 95: 347–352. [PubMed]

4. Heymann MA. Control of the pulmonary circulation in the fetus and during the transitional period to air breathing. Eur J Obstet Gynecol Reprod Biol 1999; 84: 127–132. [PubMed]

5. Swanson JR, Sinkin RA. Transition from fetus to newborn. Pediatr Clin North Am 2015; 62: 329–343. [PubMed]

6. Langston C, Kida K, Reed M, et al. Human lung growth in late gestation and in the neonate. Am Rev Respir Dis 1984; 129: 607–613. [PubMed]

7. Rubaltelli FF, Dani C, Reali MF, et al. Acute neonatal respiratory distress in Italy: a one-year prospective study. Italian Group of Neonatal Pneumology. Acta Paediatr 1998; 87: 1261–1268. [PubMed]

8. Kumar A, Bhat BV. Epidemiology of respiratory distress of newborns. Indian J Pediatr 1996; 63: 93–98. [PubMed]

9. Pramanik AK, Rangaswamy N, Gates T. Neonatal respiratory distress: a practical approach to its diagnosis and management. Pediatr Clin North Am 2015; 62: 453–469. [PubMed]

10. Parkash A, Haider N, Khoso ZA, et al. Frequency, causes and outcome of neonates with respiratory distress admitted to Neonatal Intensive Care Unit, National Institute of Child Health, Karachi. J Pak Med Assoc 2015; 65: 771–775. [PubMed]

11. Qian L, Liu C, Guo Y, et al. Current status of neonatal acute respiratory disorders: a one-year prospective survey from a Chinese neonatal network. Chin Med J (Engl) 2010; 123: 2769–2775. [PubMed]

12. Ersch J, Roth-Kleiner M, Baeckert P, et al. Increasing incidence of respiratory distress in neonates. Acta Paediatr 2007; 96: 1577–1581. [PubMed]

13. Kotecha SJ, Gallacher DJ, Kotecha S. The respiratory consequences of early-term birth and delivery by caesarean sections. Paediatr Respir Rev 2015; 1–7. [PubMed]

14. Edwards MO, Kotecha SJ, Kotecha S. Respiratory distress of the term newborn infant. Paediatr Respir Rev 2013; 14: 29–36. [PubMed]

15. Kotecha SJ, Adappa R, Gupta N, et al. Safety and efficacy of high-flow nasal cannula therapy in preterm infants: a meta-analysis. Pediatrics 2015; 136: 542–553. [PubMed]

16. Ghafoor T, Mahmud S, Ali S, et al. Incidence of respiratory distress syndrome. J Coll Physicians Surg Pak 2003; 13: 271–273. [PubMed]

17. Dani C, Reali MF, Bertini G, et al. Risk factors for the development of respiratory distress syndrome and transient tachypnoea in newborn infants. Eur Respir J 1999; 14: 155–159. [PubMed]

18. Joshi S, Kotecha S. Lung growth and development. Early Hum Dev 2007; 83: 789–794. [PubMed]

19. Hallman M, Merritt TA, Pohjavuori M, et al. Effect of surfactant substitution on lung effluent phospholipids in respiratory distress syndrome: evaluation of surfactant phospholipid turnover, pool size, and the relationship to severity of respiratory failure. Pediatr Res 1986; 20: 1228–1235. [PubMed]

20. Pickerd N, Kotecha S. Pathophysiology of respiratory distress syndrome. Paediatr Child Health (Oxford) 2009; 19: 153–157.

21. Morris SJ. Radiology of the chest in neonates. Paediatr Child Health (Oxford) 2003; 13: 460–468.

22. Wapner RJ. Antenatal corticosteroids for periviable birth. Semin Perinatol 2013; 37: 410–413. [PMC free article][PubMed]

23. Roberts D, Dalziel S. Antenatal corticosteroids for accelerating fetal lung maturation for women at risk of preterm birth. Cochrane Database Syst Rev 2006; 3: CD004454. [PubMed]

24. Aguar M, Nuñez A, Cubells E, et al. Administration of surfactant using less invasive techniques as a part of a non-aggressive paradigm towards preterm infants. Early Hum Dev 2014; 90: Suppl 2, S57–S59. [PubMed]

25. Sweet DG, Carnielli V, Greisen G, et al. European Consensus Guidelines on the Management of Neonatal Respiratory Distress Syndrome in Preterm Infants: 2013 Update. Neonatology 2013; 103: 353–368. [PubMed]

26. Manley BJ, Dold SK, Davis PG, et al. High-flow nasal cannulae for respiratory support of preterm infants: a review of the evidence. Neonatology 2012; 102: 300–308. [PubMed]

27. Greenough A. Long term respiratory outcomes of very premature birth (<32 weeks). Seminars in Fetal and Neonatal Medicine 2012; 73–76. [PubMed]

28. Trembath A, Laughon MM. Predictors of bronchopulmonary dysplasia. Clin Perinatol 2012; 39: 585–601. [PMC free article][PubMed]

29. Bose C, Van Marter LJ, Laughon M, et al. Fetal growth restriction and chronic lung disease among infants born before the 28th week of gestation. Pediatrics 2009; 124: e450–e458. [PMC free article][PubMed]

30. Van Marter LJ, Dammann O, Allred EN, et al. Chorioamnionitis, mechanical ventilation, and postnatal sepsis as modulators of chronic lung disease in preterm infants. J Pediatr 2002; 140: 171–176. [PubMed]

31. Bhandari V. Hyperoxia-derived lung damage in preterm infants. Semin Fetal Neonatal Med 2010; 15: 223–229. [PMC free article][PubMed]

32. Gonzalez A, Sosenko IR, Chandar J, et al. Influence of infection on patent ductus arteriosus and chronic lung disease in premature infants weighing 1000 grams or less. J  Pediatr 1996; 128: 470–478. [PubMed]

33. Chakraborty M, McGreal EP, Kotecha S. Acute lung injury in preterm newborn infants: mechanisms and management. Paediatr Respir Rev 2010; 11: 162–170; quiz 170. [PubMed]

34. Kotecha S, Chan B, Azam N, et al. Increase in interleukin-8 and soluble intercellular adhesion molecule-1 in bronchoalveolar lavage fluid from premature infants who develop chronic lung disease. Arch Dis Child Fetal Neonatal Ed 1995; 72: F90–F96. [PMC free article][PubMed]

35. Schneibel KR, Fitzpatrick AM, Ping X-D, et al. Inflammatory mediator patterns in tracheal aspirate and their association with bronchopulmonary dysplasia in very low birth weight neonates. J Perinatol 2013; 33: 383–387. [PMC free article][PubMed]

36. Kotecha S, Wilson L, Wangoo A, et al. Increase in interleukin (IL)-1 beta and IL-6 in bronchoalveolar lavage fluid obtained from infants with chronic lung disease of prematurity. Pediatr Res 1996; 40: 250–256. [PubMed]

37. Kotecha S, Mildner RJ, Prince LR, et al. The role of neutrophil apoptosis in the resolution of acute lung injury in newborn infants. Thorax 2003; 58: 961–967. [PMC free article][PubMed]

38. Chakraborty M, McGreal EP, Williams A, et al. Role of serine proteases in the regulation of interleukin-877 during the development of bronchopulmonary dysplasia in preterm ventilated infants. PLoS One 2014; 9: e114524. [PMC free article][PubMed]

39. Jensen EA, Schmidt B. Epidemiology of bronchopulmonary dysplasia. Birth Defects Res Part A - Clin Mol Teratol 2014; 100: 145–157. [PubMed]

40. Jobe AH. The New BPD. NeoReviews 2006; e531–e545.

41. Northway WH, Rosan RC, Porter DY. Pulmonary disease following respirator therapy of hyaline-membrane disease. Bronchopulmonary dysplasia. N Engl J Med 1967; 276: 357–368. [PubMed]

42. Jobe AJ. The new BPD: an arrest of lung development. Pediatr Res 1999; 46: 641–643. [PubMed]

43. Shah VS, Ohlsson A, Halliday HL, et al. Early administration of inhaled corticosteroids for preventing chronic lung disease in ventilated very low birth weight preterm neonates. Cochrane Database Syst Rev 2012; 5: CD001969. [PubMed]

44. Stewart A, Brion LP, Ambrosio-Perez I. Diuretics acting on the distal renal tubule for preterm infants with (or developing) chronic lung disease. Cochrane Database Syst Rev 2011; 9: CD001817. [PubMed]

45. Griscom NT, Wheeler WB, Sweezey NB, et al. Bronchopulmonary dysplasia: radiographic appearance in middle childhood. Radiology 1989; 171: 811–814.

Respiratory distress syndrome (RDS) is a breathing disorder that affects newborns. The disorder is more common in premature infants.

What Is Respiratory Distress Syndrome?

Respiratory distress syndrome (RDS) is a breathing disorder that affects newborns. RDS rarely occurs in full-term infants. The disorder is more common in premature infants born about 6 weeks or more before their due dates.

RDS is more common in premature infants because their lungs aren't able to make enough surfactant (sur-FAK-tant). Surfactant is a liquid that coats the inside of the lungs. It helps keep them open so that infants can breathe in air once they're born.

Without enough surfactant, the lungs collapse and the infant has to work hard to breathe. He or she might not be able to breathe in enough oxygen to support the body's organs. The lack of oxygen can damage the baby's brain and other organs if proper treatment isn't given.

Most babies who develop RDS show signs of breathing problems and a lack of oxygen at birth or within the first few hours that follow.

Overview

RDS is a common lung disorder in premature infants. In fact, nearly all infants born before 28 weeks of pregnancy develop RDS.

RDS might be an early phase of bronchopulmonary dysplasia (brong-ko-PUL-mo-nar-e dis-PLA-ze-ah), or BPD. This is another breathing disorder that affects premature babies.

RDS usually develops in the first 24 hours after birth. If premature infants still have breathing problems by the time they reach their original due dates, they may be diagnosed with BPD. Some of the life-saving treatments used for RDS may cause BPD.

Some infants who have RDS recover and never get BPD. Infants who do get BPD have lungs that are less developed or more damaged than the infants who recover.

Infants who develop BPD usually have fewer healthy air sacs and tiny blood vessels in their lungs. Both the air sacs and the tiny blood vessels that support them are needed to breathe well.

Outlook

Due to improved treatments and medical advances, most infants who have RDS survive. However, these babies may need extra medical care after going home.

Some babies have complications from RDS or its treatments. Serious complications include chronic (ongoing) breathing problems, such as asthma and BPD; blindness; and brain damage.

Other Names for Respiratory Distress Syndrome

What Causes Respiratory Distress Syndrome?

The main cause of respiratory distress syndrome (RDS) is a lack of surfactant in the lungs. Surfactant is a liquid that coats the inside of the lungs.

A fetus's lungs start making surfactant during the third trimester of pregnancy (weeks 26 through labor and delivery). The substance coats the insides of the air sacs in the lungs. This helps keep the lungs open so breathing can occur after birth.

Without enough surfactant, the lungs will likely collapse when the infant exhales (breathes out). The infant then has to work harder to breathe. He or she might not be able to get enough oxygen to support the body's organs.

Some full-term infants develop RDS because they have faulty genes that affect how their bodies make surfactant.

Who Is at Risk for Respiratory Distress Syndrome?

Certain factors may increase the risk that your infant will have respiratory distress syndrome (RDS). These factors include:

  • Premature delivery. The earlier your baby is born, the greater his or her risk for RDS. Most cases of RDS occur in babies born before 28 weeks of pregnancy.

  • Stress during your baby's delivery, especially if you lose a lot of blood.

  • Infection.

  • Your having diabetes.

Your baby also is at greater risk for RDS if you require an emergency cesarean delivery (C-section) before your baby is full term. You may need an emergency C-section because of a condition, such as a detached placenta, that puts you or your infant at risk.

Planned C-sections that occur before a baby's lungs have fully matured also can increase the risk of RDS. Your doctor can do tests before delivery that show whether it's likely that your baby's lungs are fully developed. These tests assess the age of the fetus or lung maturity.

What Are the Signs and Symptoms of Respiratory Distress Syndrome?

Signs and symptoms of respiratory distress syndrome (RDS) usually occur at birth or within the first few hours that follow. They include:

  • Rapid, shallow breathing

  • Sharp pulling in of the chest below and between the ribs with each breath

  • Grunting sounds

  • Flaring of the nostrils

The infant also may have pauses in breathing that last for a few seconds. This condition is called apnea (AP-ne-ah).

Respiratory Distress Syndrome Complications

Depending on the severity of an infant's RDS, he or she may develop other medical problems.

Blood and Blood Vessel Complications

Infants who have RDS may develop sepsis, an infection of the bloodstream. This infection can be life threatening.

Lack of oxygen may prevent a fetalblood vessel called the ductus arteriosus from closing after birth as it should. This condition is called patent ductus arteriosus, or PDA.

The ductus arteriosus connects a lung artery to a heart artery. If it remains open, it can strain the heart and increase blood pressure in the lung arteries.

Other Complications

Complications of RDS also may include blindness and other eye problems and a bowel disease called necrotizing enterocolitis (EN-ter-o-ko-LI-tis). Infants who have severe RDS can develop kidney failure.

Some infants who have RDS develop bleeding in the brain. This bleeding can delay mental development. It also can cause mental retardation or cerebral palsy.

How Is Respiratory Distress Syndrome Diagnosed?

Respiratory distress syndrome (RDS) is common in premature infants. Thus, doctors usually recognize and begin treating the disorder as soon as babies are born.

Doctors also do several tests to rule out other conditions that could be causing an infant's breathing problems. The tests also can confirm that the doctors have diagnosed the condition correctly.

The tests include:

  • Chest x ray. A chest x ray creates a picture of the structures inside the chest, such as the heart and lungs. This test can show whether your infant has signs of RDS. A chest x ray also can detect problems, such as a collapsed lung, that may require urgent treatment.

  • Blood tests. Blood tests are used to see whether an infant has enough oxygen in his or her blood. Blood tests also can help find out whether an infection is causing the infant's breathing problems.

  • Echocardiography (echo). This test uses sound waves to create a moving picture of the heart. Echo is used to rule out heart defects as the cause of an infant's breathing problems.

How Is Respiratory Distress Syndrome Treated?

Treatment for respiratory distress syndrome (RDS) usually begins as soon as an infant is born, sometimes in the delivery room.

Most infants who show signs of RDS are quickly moved to a neonatal intensive care unit (NICU). There they receive around-the-clock treatment from health care professionals who specialize in treating premature infants.

The most important treatments for RDS are:

  • Surfactant replacement therapy.

  • Breathing support from a ventilator or nasal continuous positive airway pressure (NCPAP) machine. These machines help premature infants breathe better.

  • Oxygen therapy.

Surfactant Replacement Therapy

Surfactant is a liquid that coats the inside of the lungs. It helps keep them open so that an infant can breathe in air once he or she is born.

Babies who have RDS are given surfactant until their lungs are able to start making the substance on their own. Surfactant usually is given through a breathing tube. The tube allows the surfactant to go directly into the baby's lungs.

Once the surfactant is given, the breathing tube is connected to a ventilator, or the baby may get breathing support from NCPAP.

Surfactant often is given right after birth in the delivery room to try to prevent or treat RDS. It also may be given several times in the days that follow, until the baby is able to breathe better.

Some women are given medicines called corticosteroids during pregnancy. These medicines can speed up surfactant production and lung development in a fetus. Even if you had these medicines, your infant may still need surfactant replacement therapy after birth.

Breathing Support

Infants who have RDS often need breathing support until their lungs start making enough surfactant. Until recently, a mechanical ventilator usually was used. The ventilator was connected to a breathing tube that ran through the infant's mouth or nose into the windpipe.

Today, more and more infants are receiving breathing support from NCPAP. NCPAP gently pushes air into the baby's lungs through prongs placed in the infant's nostrils.

Oxygen Therapy

Infants who have breathing problems may get oxygen therapy. Oxygen is given through a ventilator or NCPAP machine, or through a tube in the nose. This treatment ensures that the infants' organs get enough oxygen to work well.

For more information, go to the Health Topics Oxygen Therapy article.

Other Treatments

Other treatments for RDS include medicines, supportive therapy, and treatment for patent ductus arteriosus (PDA). PDA is a condition that affects some premature infants.

Medicines

Doctors often give antibiotics to infants who have RDS to control infections (if the doctors suspect that an infant has an infection).

Supportive Therapy

Treatment in the NICU helps limit stress on babies and meet their basic needs of warmth, nutrition, and protection. Such treatment may include:

  • Using a radiant warmer or incubator to keep infants warm and reduce the risk of infection.

  • Ongoing monitoring of blood pressure, heart rate, breathing, and temperature through sensors taped to the babies' bodies.

  • Using sensors on fingers or toes to check the amount of oxygen in the infants' blood.

  • Giving fluids and nutrients through needles or tubes inserted into the infants' veins. This helps prevent malnutrition and promotes growth. Nutrition is critical to the growth and development of the lungs. Later, babies may be given breast milk or infant formula through feeding tubes that are passed through their noses or mouths and into their throats.

  • Checking fluid intake to make sure that fluid doesn't build up in the babies' lungs.

Treatment for Patent Ductus Arteriosus

PDA is a possible complication of RDS. In this condition, a fetalblood vessel called the ductus arteriosus doesn't close after birth as it should.

The ductus arteriosus connects a lung artery to a heart artery. If it remains open, it can strain the heart and increase blood pressure in the lung arteries.

PDA is treated with medicines, catheter procedures, and surgery. For more information, go to the Health Topics Patent Ductus Arteriosus article.

How Can Respiratory Distress Syndrome Be Prevented?

Taking steps to ensure a healthy pregnancy might prevent your infant from being born before his or her lungs have fully developed. These steps include:

  • Seeing your doctor regularly during your pregnancy

  • Following a healthy diet

  • Avoiding tobacco smoke, alcohol, and illegal drugs

  • Managing any medical conditions you have

  • Preventing infections

If you're having a planned cesarean delivery (C-section), your doctor can do tests before delivery to show whether it's likely that your baby's lungs are fully developed. These tests assess the age of the fetus or lung maturity.

Your doctor may give you injections of a corticosteroid medicine if he or she thinks you may give birth too early. This medicine can speed up surfactant production and development of the lungs, brain, and kidneys in your baby.

Treatment with corticosteroids can reduce your baby's risk of respiratory distress syndrome (RDS). If the baby does develop RDS, it will probably be fairly mild.

Corticosteroid treatment also can reduce the chances that your baby will have bleeding in the brain.

Living With Respiratory Distress Syndrome

Caring for a premature infant can be challenging. You may experience:

  • Emotional distress, including feelings of guilt, anger, and depression.

  • Anxiety about your baby's future.

  • A feeling of a lack of control over the situation.

  • Financial stress.

  • Problems relating to your baby while he or she is in the neonatal intensive care unit (NICU).

  • Fatigue (tiredness).

  • Frustration that you can't breastfeed your infant right away. (You can pump and store your breast milk for later use.)

Take Steps to Manage Your Situation

You can take steps to help yourself during this difficult time. For example, take care of your health so that you have enough energy to deal with the situation.

Learn as much as you can about what goes on in the NICU. You can help your baby during his or her stay there and begin to bond with the baby before he or she comes home.

Learn as much as you can about your infant's condition and what's involved in daily care. This will allow you to ask questions and feel more confident about your ability to care for your baby at home.

Seek out support from family, friends, and hospital staff. Ask the case manager or social worker at the hospital about what you'll need after your baby leaves the hospital. The doctors and nurses can assist with questions about your infant's care. Also, you may want to ask whether your community has a support group for parents of premature infants.

Parents are encouraged to visit their baby in the NICU as much as possible. Spend time talking to your baby and holding and touching him or her (when allowed).

Ongoing Care for Your Infant

Your baby may need special care after leaving the NICU, including:

Talk to your child's doctor about ongoing care for your infant and any other medical concerns you have.

Clinical Trials

The National Heart, Lung, and Blood Institute (NHLBI) is strongly committed to supporting research aimed at preventing and treating heart, lung, and blood diseases and conditions and sleep disorders.

NHLBI-supported research has led to many advances in medical knowledge and care. However, many questions remain about various diseases and conditions, including respiratory distress syndrome (RDS).

The NHLBI continues to support research aimed at learning more about RDS. For example, NHLBI-supported research includes studies that explore:

  • Whether corticosteroid treatment given to pregnant women 12–24 hours before delivery can decrease late preterm infants' need for oxygen support. (Late preterm infants are babies born between 34 and 36 weeks of pregnancy.)

  • Whether late doses of surfactant in patients receiving nitric oxide can help prevent bronchopulmonary dysplasia.

  • The role that genes play in surfactant deficiency and new ways to treat this problem in newborns.

Much of this research depends on the willingness of volunteers to take part in clinical trials. Clinical trials test new ways to prevent, diagnose, or treat various diseases and conditions.

For example, new treatments for a disease or condition (such as medicines, medical devices, surgeries, or procedures) are tested in volunteers who have the illness. Testing shows whether a treatment is safe and effective in humans before it is made available for widespread use.

By taking part in a clinical trial, your child may gain access to new treatments before they're widely available. Your child also will have the support of a team of health care providers, who will likely monitor his or her health closely. Even if your child doesn't directly benefit from the results of a clinical trial, the information gathered can help others and add to scientific knowledge.

Children (aged 18 and younger) get special protection as research subjects. Almost always, parents must give legal consent for their child to take part in a clinical trial.

When researchers think that a trial's potential risks are greater than minimal, both parents must give permission for their child to enroll. Also, children aged 7 and older often must agree (assent) to take part in clinical trials.

If you agree to have your child take part in a clinical trial, you'll be asked to sign an informed consent form. This form is not a contract. You have the right to withdraw your child from a study at any time, for any reason. Also, you have the right to learn about new risks or findings that emerge during the trial.

For more information about clinical trials related to RDS, talk with your doctor. For more information about clinical trials for children, visit the NHLBI's Children and Clinical Studies Web page.

You also can visit the following Web sites to learn more about clinical research and to search for clinical trials:

One thought on “Full Term Infant Respiratory Distress Syndrome Essay

Leave a Reply

Your email address will not be published. Required fields are marked *