On average, a developing baby’s lungs are considered to be mature and fully functional around 35 to 36 weeks after conception. For babies born before that, breathing can be a serious challenge. Respiratory distress syndrome (RDS) is the most common illness in the NICU. RDS can be mild or quite severe, but the good news is that 99% of babies with RDS survive. The babies who don’t survive usually are the youngest, smallest babies born before 26 weeks of gestation.
Surfactant is a foamy substance that lines the lungs in mature babies and keeps them from collapsing, making breathing in and out easier. Premature babies lack surfactant and their lungs collapse between breaths. This makes inhaling air and exhaling carbon dioxide very difficult. The energy it takes to expand and contract the lungs can be exhausting and overwhelming for these tiny babies.
Research has shown us that the earlier a baby is born the less surfactant is likely to exist in the lungs and the more likely it is for him to develop RDS. Boys are more likely to get RDS than girls because their lungs mature more slowly. Preemies with mothers who have diabetes or with Rh blood-type incompatibilities are at greater risk for RDS because their lungs are slower to produce surfactant. Babies with mothers who have severe preeclampsia are more vulnerable to RDS because their normal lung development is disrupted. Babies born via cesarean delivery and without labor are at increased risk for RDS. This is because labor produces hormones that promote lung maturation and uterine contractions may help squeeze excess fluid from a baby’s lungs, making breathing easier.
Most babies who will get RDS show symptoms within a few hours of birth. RDS usually gets worse for a couple of days and then improves as the baby starts to produce more surfactant. Treatment includes giving a dose or two of man-made surfactant and providing breathing assistance with oxygen, C-PAP or mechanical ventilation, depending on each baby’s needs.
While the survival rate is extremely high, severe RDS may lead to longer-term health problems. Mechanical ventilation can be life-saving, but it is harsh. Chronic lung disease, also known as bronchopulomonary dysplasia (BPD), comes as a result of inflammation and scaring of the lungs that may result from ventilation. Children with severe RDS also have an increased likelihood of asthma.