Infant Respiratory Distress Syndrome ( RDS Disease) Hyaline Membrane Disease

Infant Respiratory distress syndrome is a disorder commonly found in premature infants, which makes breathing difficult, due to the collapse of the air sacs in the lungs of the newborn.

This condition, also called hyaline membrane disease or RDS disease, is caused by the absence or insufficiency of a substance called surfactant which normally helps in the expansion of the alveoli or air sacs in the lungs and in keeping them open during exhalation.

  • Infants with respiratory distress syndrome display labored breathing and their skin develops a bluish tinge due to inadequate oxygenation of blood.
  • Lack or insufficiency of surfactant, common in infants born prematurely, or in those born to mothers who have diabetes, is the usual cause of respiratory distress syndrome in newborns.
  • The typical symptoms help diagnose the condition in newborns. The abnormally low levels of oxygen in the blood, and an x-ray of the chest, can confirm the diagnosis.
  • Without immediate medical intervention and adequate respiratory support, brain damage, as well as death, may result from continued respiratory distress.
  • When the pregnancy is expected to end before completing the normal term, and when insufficiency of surfactant is anticipated, as a preventive measure, corticosteroid injections are given to the mother, to accelerate surfactant production in the fetus.
  • When the newborn infant shows respiratory distress, supplementary oxygen is administered, or ventilator support is provided, as necessary.
  • Surfactant is administered into the trachea of infants who have respiratory distress due to deficiency of the substance.

For the normal functioning of the lungs, the alveoli or air sacs in the lungs should get filled with inhaled air easily, and they should remain open without collapsing between breaths. Surfactant is a substance produced by the lungs, which forms a coating on the air sacs and helps in lowering the surface tension, making it easy for the air sacs to expand and to stay open during the entire cycle of respiration. The substance is produced only towards the end of the normal gestational period, typically after the fetus completes 32 weeks in the mother’s womb. As the pregnancy progresses, more and more of the surfactant is deposited in the lungs. When the infant is born before term, the insufficiency of the surfactant leads to infant respiratory distress syndrome. The severity of the condition depends on how premature the infant is, when it is delivered. The infants born to mothers who are diabetic are more prone to developing this disorder. Although, an inherited form of this syndrome is found to occur in rare cases, respiratory distress syndrome is considered almost exclusively to be a complication of prematurity.

Symptoms and Diagnosis

When newborns have respiratory distress syndrome, their lungs cannot expand well and easily as they remain stiff. More effort is needed to fill the lungs with air during inhalation, and when the air is exhaled, the alveoli or the air sacs collapse again. In extremely premature infants, the stiffness of the lungs may prevent the filling up of the air sacs and the newborn cannot breathe at all without the help of mechanical ventilation. More often, the premature infants with immature lungs can breathe, but with a lot of effort. The breathing is labored, and the blood levels of oxygen remain low. This condition is known as respiratory distress syndrome.

The visible symptoms of this disorder include the nostrils flaring up wide during inhalation, and a grunting sound during exhalation. The chest is drawn in below the infant’s rib cage, and a bluish tinge to the skin known as cyanosis appear due to poor oxygenation of blood. Eventually, the muscles involved in the respiratory process begin to tire out from the extra effort needed, and more and more air sacs begin to collapse, as the little surfactant present in the lungs gets exhausted. Without timely medical intervention and adequate respiratory support, the brain and the other organs get damaged due to lack of oxygen supply, and death may result.

Respiratory distress syndrome is diagnosed from the symptoms displayed by the newborn. It is confirmed by the abnormally low oxygen levels in the infant’s blood. A chest x-ray can also show the abnormal condition of the lungs.

Prevention and Treatment

Premature infant Respiratory distress syndrome can be prevented if the delivery is delayed till the lungs become mature enough for independent function. Sufficient amount of the substance called surfactant, which lowers the surface tension, and facilitates the easy extension of the air sacs in the lungs, is necessary to prevent the lungs from collapsing every time the air is pumped out. If it is not possible to delay delivery, a corticosteroid such as betamethasone may be injected into the mother. The steroid crosses the placenta and reaches the fetus. The drug works by accelerating surfactant production and maturation of the infant’s lungs. Within two days of the injection, the lungs of the fetus may become ready for independent function after birth. If a slight respiratory distress is displayed, it may be much milder and the infant may not require ventilator support.

When the newborn is having a mild form of respiratory distress syndrome, oxygen is given either through an oxygen hood placed over the infant’s head, or using prongs which are placed in the nose. The infant breaths normally, but the oxygen-rich air helps to maintain the blood oxygen levels. But supplemental oxygen may have to be administered by another technique called continuous positive airway pressure or CPAP, if the respiratory distress is severe. In this technique, the infant takes in the breaths normally but the air or oxygen supplied via prongs in the nostrils is pressurized to keep the airway open, and to prevent the lungs from collapsing. In extremely severe cases of respiratory distress syndrome, even CPAP may not be sufficient. In such cases, an endotracheal tube is inserted into the trachea or windpipe of the infant, and ventilator support is given, to assist with breathing.

It is mainly the lack of sufficient amount of surfactant in the lungs that causes respiratory distress syndrome in the newborns, especially in those who are born pre-term. To counteract this, a surfactant can be administered as soon as the infant is born. It can prevent the rupture of lungs which may otherwise lead to the potentially fatal condition called pneumothorax. This life-saving measure can be initiated even before the symptoms of respiratory distress appear in the newborns, and prevent its occurrence. Premature babies who are exhibiting the symptoms of respiratory distress are also given surfactant treatment as early as possible. The surfactant administered to the infant through the endotracheal tube functions exactly like the naturally occurring surfactant. Repeated administration of the surfactant over the first few days may be necessary, till the symptoms of respiratory distress syndrome disappear and the infant can be taken off the ventilator support.

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Yasser Elnahas

MD, PHD, Professor Of CardioVascular Surgery
Dr. Yasser Elnahas, Is an associate Professor of Cardiovascular Surgery. Dr. Elnahas was trained as a fellow At Texas Heart Institute And Mayo Clinic Foundation.Dr. Elnahas is dedicated to educating the general public about different disease conditions and simplifying the medical knowledge in an easy to understand terminology.

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