Respiratory Distress Syndrome In Newborns

GENERAL INFORMATION:

What is it? Respiratory (RES-pir-ah-tohr-ee) distress syndrome (RDS) is a breathing problem in newborns. It may start within minutes to hours after your baby is born. It is most common in premature infants (babies born too early) because their lungs may not be fully formed. RDS in a baby whose lungs are not fully developed is also called hyaline membrane disease. A baby with RDS may breathe very fast and hard to try to supply enough oxygen to his lungs, heart, and tissues. The type of treatment your baby receives for his RDS will depend on a number of factors. These include size, gestational age (how many weeks premature your baby is) and how severe (bad) the RDS is.

What causes RDS? If a baby is premature, his lungs may not make enough surfactant. Surfactant is a slippery liquid (like soap suds) inside the tiny air sacs of the lung tissue. Surfactant keeps the tiny air sacs open so your baby can get enough oxygen as he breathes. Without enough surfactant, the air sacs collapse and cause breathing problems. A baby born to a mother with diabetes is at higher risk for getting RDS.

What are the signs and symptoms of RDS? A baby with RDS cannot breathe well enough to remain healthy. Your baby may have one or more of the following:

• Very fast breathing, or periods of no breathing (apnea).
  
  
• Grunting sounds, especially when exhaling (breathing out).
  
  
• Retractions. The skin between and around the ribs pulls in when your baby inhales (breathes in). The middle of your baby's chest may also sink deeply in as he breathes.
  
  
• Nasal flaring. The two nose openings become larger with breathing.
  
  
• Pale or blue colored skin, lips, and nailbeds.

How is RDS diagnosed? Your baby's caregiver will do a medical exam on your baby. The caregiver will do tests to help plan your baby's care. Some of these tests may need to be done often. Your baby may need one or more of the following tests:

• Arterial blood gases: An arterial blood gas is also called an "ABG". ABGs show caregivers how much oxygen, acids, and carbon dioxide are in your baby's blood.
  
  
• Blood tests: Blood may be taken to learn if your baby has an infection or other problems. Your baby may need to have blood taken many times.
  
  
• Chest x-ray: This is a picture of your baby's lungs and heart. Caregivers can look at x-rays to learn if your baby has RDS or other problems.
  
  
• Pulse oximeter: This is a machine that tells how much oxygen is in your baby's blood. Caregivers use this machine to see if your baby needs more oxygen.

What are the risks of having RDS?

• If your baby does not get treatment for RDS, his breathing problems will get worse. Your baby may have bleeding inside his head or lungs. Your baby may get an infection or stomach and heart problems. Your baby may need an endotracheal (ET) tube and breathing machine to help him breathe. Rarely, an ET tube may cause your baby's vocal cords (voice box) to stop working for a while. Your baby may develop air leaks into his lung tissue, chest, or abdomen (belly). Your baby may get a blood clot from having umbilical catheters.
  
  
• Having RDS may cause your baby to develop long-term medical problems. These include long-term lung problems, bad vision (sight), and blindness (usually in very premature babies). These also include learning and coordination (movement) problems, or brain damage. With or without treatment, your baby's RDS may become so severe that he could die.

How is RDS treated? Babies with RDS are usually taken to a neonatal intensive care unit (NICU). Your baby may lie in an incubator or on a warming bed. An incubator is a clear plastic box with a small bed inside. Caregivers will watch your baby very closely. They will do tests, watch bedside monitors, and check your baby often. Your baby may have one or more of the following:

• Breathing support:
  
  
  • Oxygen: Your baby may need extra oxygen to help him breathe better. The oxygen may be warmed and mixed with mist (water vapor). Caregivers may place a clear oxygen hood over your baby's head. Your baby may need CPAP (continuous positive airway pressure) given through nasal prongs. With CPAP, your baby will have a long, plastic tube with two tiny tubes sticking up from it (nasal prongs). The nasal prongs are gently inserted into your baby's nostrils (nose openings) and taped in place. CPAP helps your baby keep his lungs filled with air.
    
    
  • ET tube: Your baby may have an endotracheal tube or "ET tube" put down his throat or nose. A long plastic tube connects the ET tube to a breathing machine called a ventilator. As your baby gets better, caregivers will "wean" your baby from his ventilator. They will check to see if your baby can breathe without help from the ventilator. Once your baby is able to breathe without the help of a ventilator, caregivers will remove the ET tube.
    
    
  • Chest physiotherapy and suctioning: Chest physiotherapy (CPT) and suctioning may be done often. Caregivers do this to loosen up the mucus (fluid) in your baby's lungs and keep his airways clear. This will help your baby to breathe easier. A caregiver will tap or vibrate over your baby's chest, then remove any loose mucus.
  
  
• Lines:
  
  
  • Arterial line: This is a tiny tube that is placed in the artery (blood vessel) of your baby's arm or leg. It is hooked to a machine that will give your baby liquid. Caregivers may use an arterial line for drawing ABGs.
    
    
  • IV lines: An IV is a tiny tube placed in your baby's vein (blood vessel). Your baby's IV will be connected to a machine that will give your baby liquids and medicine.
    
    
  • Umbilical catheters: These tiny tubes may be put into the blood vessels of the umbilical cord stump. The umbilical stump sticks out of the belly button. The umbilical stump is part of the umbilical cord that connected you to your baby before birth. This catheter helps caregivers measure blood and heart pressure, draw blood, and give medicine, blood, and fluid. He may also be fed through this catheter.
  
  
• Medicines:
  
  
  • Surfactant replacement therapy after birth: Surfactant is medicine that is used to treat hyaline membrane disease (HMD). It may help prevent RDS or make it less severe. Surfactant may be given at birth through a tube to help prevent RDS. Your baby may receive one or more doses.
    
    
  • Bronchodilators: This medicine may be given to open up your baby's airways so that he can breathe easier.
    
    
  • Diuretics: This medicine may be given to help your baby's body get rid of extra fluid or water. Getting rid of extra fluid may help your baby breathe easier.
    
    
  • Pain medicine: This medicine may help keep your baby calm and comfortable if he has pain.
    
    
  • Sedatives: This medicine helps to keep your baby calm while he gets better.
    
    
  • Steroids: This medicine may be given to help decrease inflammation in the airways and lungs. Inflammation causes the airways to be swollen and red, and to make too much thick fluid.
  
  
• Monitors and tests: Your baby may have many machines at his bedside. These machines help to monitor (watch carefully) and test how your baby is doing. The results of the monitors and test will help caregivers plan the best treatment for your baby.
  
  
  • Arterial blood gases (ABGS): Blood for an ABG may be taken from your baby's UAC (umbilical catheter). It may be taken from an arterial line, or an artery in the arm, wrist, leg, or foot. ABG results help caregivers know how to increase or decrease your baby's oxygen levels and ventilator.
    
    
  • Blood tests: These tests help caregivers to know more about your baby's health. Blood for these tests is usually taken from your baby's UAC, or from his heel.
    
    
  • Chest x-rays: These help caregivers know how your baby's lungs and heart are doing. If your baby has a ventilator, x-rays can also show if the ET tube is in the correct place.
    
    
  • Heart monitor: This is also called an ECG or an electrocardiogram. Three sticky pads are placed on your baby's body. Each pad has a wire that is connected to a TV-type screen. This screen shows a tracing (picture) of each heartbeat. Your baby's heart is being watched all the time to make sure he is doing OK.
    
    
  • Pulse oximeter: This machine tells caregivers what your baby's oxygen levels are all the time. Never turn the pulse oximeter off, even if an alarm is sounding.
    
    
  • Vital signs: This includes taking your baby's temperature, blood pressure, pulse (heartbeats), and respirations (breathing). Caregivers may use your baby's catheter or will wrap a tiny cuff around your baby's arm to measure blood pressure. They may use the catheter to measure the pressure of blood in your baby's heart. Caregivers will listen for pulse and respirations with a stethoscope. Temperature will be taken by a tiny skin probe taped to your baby's skin or with a thermometer.

What can I do to help my baby while he has RDS?

• You may sit at your baby's bedside to give him comfort and support. You may talk to your baby or stroke him gently. Ask your caregiver about the best ways to comfort your baby.
  
  
• If you plan to breast feed, it is important to start pumping your breasts as soon as possible. Ask caregivers for information about using a breast pump to collect your milk, and how to store the milk for your baby to drink later.

CARE AGREEMENT:

You have the right to help plan your baby's care. To help with this plan, you must learn about your baby's health condition and how it may be treated. You can then discuss treatment options with your baby's caregivers. Work with them to decide what care may be used to treat your baby.

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