Parents should suspect respiratory distress syndrome when newborns show rapid breathing and cyanosis

When a newborn baby can't breathe properly and has blue lips or face, it's a cause for great anxiety for parents.

Respiratory distress syndrome (RDS) is a condition that affects preterm infants due to their immature lungs, and survival rates vary greatly depending on the timing of treatment.

RDS is caused by underdeveloped lungs and a lack of “pulmonary surface-active agents” that inflate the lungs. Just like blowing up a tough, small balloon that doesn't blow well, lungs that lack pulmonary surface activator don't stretch as well, making it harder to breathe.

The risk of RDS increases the earlier the baby is born, with a 60-80 percent incidence before 28 weeks' gestation. Between 32 and 36 weeks, the incidence is 15-30 percent, and it is rare, occurring in about 1 percent of full-term babies. The prevalence is generally higher in boys than girls, according to pediatrics.

In addition to preterm birth, RDS can also occur in full-term infants if the mother has diabetes, the baby has a thoracic malformation, a congenital diaphragmatic hernia, or a gene mutation in the protein that makes a pulmonary surface-active agent. Other causes include multiple fetuses and maternal hemorrhage.

RDS is characterized by difficulty breathing shortly after birth and worsens over time. Symptoms include a baby's respiratory rate increasing to more than 70 breaths per minute, severely depressed breathing with the ribs tucked in when breathing, persistent apnea, grunting sounds when breathing, and cyanosis of the lips and face.

Diagnosis is based on clinical symptoms, chest X-rays, and blood tests. In severe cases, the lungs may appear entirely white, making it difficult to distinguish them from the heart.

Treatment involves the use of a man-made drug called a pulmonary surface-active substance, which is administered directly to the lungs through a tracheal tube. In addition to treatment with lung surface-active agents, conservative treatment is also provided with adequate respiratory support, including mechanical ventilation and oxygen administration. Recently, noninvasive respiratory support is recommended instead of intubation, followed by selective administration of medications as needed.

“Clinical research and development of noninvasive administration of inhaled pulmonary surface-active agents is being actively conducted at home and abroad,” said Professor Park Ga-young of the Department of Pediatrics at Soon Chun Hyang University Hospital Bucheon. “If proven effective, it will help reduce the risk of complications by delivering drugs to the lungs without the need for intubation.”

If a preterm birth is expected, the most effective prevention is to give the mother steroids to help the baby's lungs mature. That helps reduce neonatal respiratory distress syndrome as well as severe respiratory complications. If the baby is due between 24 and 36 weeks of pregnancy, steroids are recommended within one week of delivery. It is also advisable to avoid a medically unnecessary cesarean section or forceful induction before labor progresses.

For high-risk mothers or those who are expected to deliver prematurely, it is essential to deliver in a hospital where both mother and newborn can be cared for, or if the newborn develops postnatal respiratory distress, to quickly transfer to a hospital with specialized care.

“It is more common than you might think for late preterm or full-term infants to show RDS, which can be difficult to differentiate from relatively mild ‘neonatal transient tachypnea’ based on initial symptoms alone,” Professor Park said. “Therefore, high-risk mothers should choose a hospital experienced in treating high-risk preterm infants, as well as late preterm infants who are transferred for respiratory distress, and that provides immediate care and specialized treatment for complications."