Respiratory distress syndrome (RDS) occurs mainly in infants who are born prematurely. It causes newborns to have difficulty breathing. If it is not properly treated, RDS can result in complications, such as an infection of the bloodstream and bleeding into the brain. In severe cases, RDS can lead to convulsions and death.


RDS occurs in premature infants because their lungs have not developed enough. Immature lungs lack surfactant. Surfactant is a foamy fluid that is crucial for the air sacs in the lungs to expand and take in air. When there is not enough surfactant, the lungs cannot expand and the baby has a hard time breathing.

The chance of developing RDS decreases as the fetus grows. Babies born after 36 weeks rarely develop this condition.

Respiratory System of an Infant

factsheet image
© 2009 Nucleus Medical Art, Inc.

Risk Factors

A risk factor is something that increases your chance of getting a disease or condition.

  • Birth before 37 weeks; this condition is more common and more severe with greater prematurity
  • Mother with insulin dependent diabetes]]>
  • Multiple birth
  • Cesarean section delivery
  • Cold stress
  • Asphyxia
  • Precipitous delivery
  • Previously affected infant
  • Male



The following symptoms usually start immediately or within a few hours after birth:

  • Difficulty breathing, apnea
  • Rapid, shallow breathing
  • Delayed or weak cry
  • Grunting noise with every breath
  • Flaring of the nostrils
  • Frothing at the lips
  • Blue color around the lips and nailbeds
  • Swelling of the extremities
  • Decreased urine output


The doctor will ask about the mother's medical history and pregnancy. The baby will also be evaluated, as outlined here:

Before Birth

Amniotic fluid may be tested for indicators of fetal lung maturity such as:

  • Surfactant
  • Lecithin:sphingomyelin ratio
  • Phosphatidyl glycerol

After Birth

  • Laboratory studies—performed to rule out infection
  • Physical exam—includes checking the baby's breathing and looking for bluish color around the lips and nailbeds
  • Testing for blood gases—to check the levels of oxygen and carbon dioxide in the blood
  • Chest x-ray]]> —a test that uses radiation to take a picture of structures inside the body, in this case, the chest


Treatment for a baby with RDS usually includes oxygen and may also include:

Mechanical Respirator

A mechanical respirator (breathing machine) is used to keep the air sacs from collapsing and to improve the exchange of oxygen and other gases in the lungs. This treatment helps the baby breathe better and is almost always required in severe RDS. High-frequency ventilation may be used to reduce lung injury.

Surfactant Treatment

Surfactant can be given to help the air sacs in the lungs expand and take in more oxygen. There are two options, both of which are delivered directly into the baby's windpipe. One type of surfactant comes from cows and the other is synthetic. As the surfactant takes effect, use of the respirator can gradually be reduced.

Inhaled Nitric Oxide

This inhaled gas may be used to improve oxygenation.

Nutrition Support

Newborns with RDS may be given food and water by the following means:

  • Tube feeding—a tube is inserted through the baby's mouth and into the stomach
  • Parenteral feeding—nutrients are delivered directly into a vein


Steps to help prevent RDS can be taken at a few different times.

To reduce your chance of having a premature baby:

  • Get good prenatal care beginning as early as possible in pregnancy.
  • Eat a healthful diet and take vitamins suggested by your doctor.
  • Do not smoke or use alcohol or drugs.
  • Only take medicines that your doctor has approved.

If you are at high risk of giving birth to a premature baby:

  • You may be given steroids just before delivery to help your baby's lungs develop
  • Your doctor may do an amniocentesis to check the maturity of your baby's lungs and to help determine the best time for delivery

After delivery, if a premature baby has a very high chance of developing RDS, surfactant may be given right after birth to help the baby breathe better.