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Respiratory distress syndrome of the newborn

Morbus membranae hyalinae · Syndrom dechové tísně novorozence

What it is

Premature lungs make too little surfactant, so the air sacs collapse with each breath; most babies born before 28 weeks have it.

Symptoms & signs

  • Fast breathing within hours of birth
  • grunting and nasal flaring
  • chest drawn in between the ribs
  • blue colour in air
  • worsening over 2–3 days, then easing

🚩 Get help if…

  • call 112 / 911 now Grunting, flaring nostrils or ribs sucking in with each breath
  • call 112 / 911 now Blue lips or tongue
  • call 112 / 911 now Pauses in breathing, or breathing over 60 a minute
  • see a doctor soon Breathing hard during feeds or tiring quickly

Where it strikes

Medical treatment

  • Corticosteroids to the mother 24–34 weeks when preterm birth is expected — fewer deaths and less RDS (Cochrane) trials support
  • The same steroids where gestation is uncertain and newborn care weak — ACT trial: more deaths; WHO ACTION-I: fewer deaths in hospitals with adequate care mixed evidence
  • CPAP from birth for babies breathing on their own trials support
  • Surfactant through a tube or a thin catheter (LISA) trials support
  • oxygen targeted to saturations of 90–95%
  • ventilation if needed; caffeine for apnoea

Natural & lifestyle

  • Delayed cord clamping in preterm babies — fewer deaths trials support
  • warmth, skin-to-skin care and mother's milk

Emerging & experimental

  • Budesonide mixed with surfactant — PLUSS trial: no benefit not confirmed in trials
  • Nebulised surfactant
  • surfactant through a laryngeal mask

Alternative, off-label & anecdotal

Approaches used outside the guidelines, with what their supporters report and what testing has found so far.

  • Vitamin A injections for very small babies — slightly less chronic lung disease; painful, repeated injections mixed evidence
  • Routine chest physiotherapy — no benefit; can harm fragile babies not confirmed in trials

ICD codes