Newborn Respiratory Distress Syndrome (NRDS)
Medikoe Health Expert
Koramangala, bengaluru, karnataka, india, Bengaluru Feb 9, 2017
Neonatal respiratory distress disorder (NRDS), also known as infantile respiratory distress syndrome (IRDS), or increasingly surfactant deficiency disorder (SDD), is an acute lung disease that occurs in premature babies caused by insufficient development of pulmonary surfactant production and structural immaturity in lungs.
In other words, it occurs when a baby's lungs are not completely developed and cannot provide sufficient oxygen, causing breathing problems. It usually troubles premature babies born six weeks or more before their expected dates and most probably begins within the first 24 hours after birth.
NRDS is a leading cause of death in preterm infants. It can also result from a genetic problem of production of associated surfactant proteins. It affects about 1% of babies; it’s more frequent in males, offspring of diabetic mothers and the second born of premature twins and Caucasians. It is also called hyaline membrane disease.
Symptoms of NRDS (Neonatal respiratory distress Syndrome)
The symptoms are quite noticeable, immediately after birth and tend to get worse over the next few days.
The newborn respiratory distress syndrome symptoms include:
- Blue-coloured finger, toes and lips
- Shallow and rapid breathing
- Flaring nostrils/ nasal flaring
- A grunting sound while breathing
- reduced urine output
If you have given birth elsewhere but not in hospital premises and observe these symptoms, contact your nearest hospital immediately.
Causes of NRDS
NRDS usually occurs in the babies when the lungs will have a lack of surfactant, i.e. when it does not produce enough surfactant.
This substance is made up of proteins and fats and helps to keep the lungs inflated and prevents them from collapsing.
A baby starts the production of surfactant typically sometime between weeks 24 and 28 of pregnancy.
Most babies produce enough surfactant to breathe normally by week 34.
If your baby is premature, they may not have enough surfactant in their lungs to breathe correctly.
Occasionally, IRDS affects babies that are not born prematurely.
For example, when:
- The mother is diabetic
- the baby is underweight
- The lungs of the baby have not developed properly.
Almost half of all babies born between week 28 and 32 of pregnancy develop NRDS.
Recently the number of babies suffering from NRDS has reduced with the use of steroid injection, which is given to the mother at the time of premature labour.
Diagnosis of NRDS
Several tests can be used for diagnosis of NRDS and ruling out other possible causes.
The diagnostic test includes:
- a blood test to measure the amount of oxygen present in the blood of the baby and check for any infection.
- Physical examination of the baby
- A pulse oximetry test to measure the amount of oxygen present in the baby's blood using a sensor attached to their fingertip, ear to toe.
- Chest X-ray to look for the distinctive cloudy appearance of the lungs in IRDS.
Treatment of NRDS
The main motive of the therapy of NRDS is to help the baby breathe.
Treatment before birth
If you're concerned about giving birth before week 34 of pregnancy treatment can start before giving birth to the child.
You may receive a steroid injection before your baby is delivered. A second dose is usually administered 24 hours after the first dose.
The steroids stimulate the development of the baby's lungs. It's estimated that the treatment helps prevent NRDS in a third of premature births.
One may also be prescribed magnesium while the injections are taken to avoid development-related complications.
If you are prescribed magnesium sulphate for more than 5 to 7 days or several times during pregnancy, your newborn baby may be offered extra care after birth. In rare cases the prolonged use of magnesium has been linked to bone-related deformities in young.
Treatment after the birth
Treatment after the birth for NRDS is initiated by taking the baby to the neonatal unit for specialized care.
If the symptoms observed are mild, they may only need oxygen which is given through an incubator or tubes into their nose.
If symptoms observed are more severe, your baby will be subjected to a breathing machine (ventilator) to either support or increase the pace of breathing.
These treatments are usually started immediately in the delivery room before the baby is transferred to the neonatal unit.
Your baby may also receive some artificial surfactant through the breathing tube.
Treatment within 2 hours is considered more effective than being delayed.
They'll also be given some fluids and nutrition through a tube connected to a vein of the baby.
Some babies born with NRDS only need the breathing support for a few days while for others the treatment continues from weeks to months.
Premature babies often suffer multiple complications that keep them in the hospital, but generally, they're considered well enough to go home around their original delivery date.
The length of the time of the baby's stay in the hospital depends upon how early they were born from the expected delivery date.
Complications in NRDS
Most babies with NRDS are successfully treated, although the high risk of future complications remains intact.
Air can sometimes leak out of the lungs and get trapped in the chest cavity. This is known as a pneumothorax.
The pocket of the entrapped exhibits pressures on the wall of the lungs, causing them to collapse and causing other breathing difficulties.
Air leaks can be treated by inserting a tube into the chest so the trapped air can escape through it.
Babies suffering from NRDS may have internal bleeding in their lungs (pulmonary haemorrhage) and brain (cerebral haemorrhage).
Bleeding in the lungs is treated by creating air pressure through a ventilator and blood transfusion.
Bleeding in the brain is most common in babies; this is mild and doesn’t cause severe complications.
Sometimes the ventilation and surfactants provided to the baby within 24 hours cause scarring to the lungs, leading further developmental issues.
This lung scarring is called bronchopulmonary dysplasia (BPD).
Symptoms of BPD include fast and shallow breathing and shortness of breath.
Babies with severe BPD generally need additional oxygen from tubes into their nose to help them breathe.
This is stopped after a few months when the lungs have healed.
But children with BPD may need a daily dose of bronchodilators which will help them widen their airways and make breathing easier.
Can a baby die from a collapsed lung?
As above said, respiratory distress in the premature newborn is a leading cause of their death. The layers of hyaline membranes maintain the oxygen that is inhaled in from passing into the blood. The lungs are told to be airless. Without treatment, the baby will die within a few days post-birth, but if oxygen can be given, and the newborn gets modern treatment in a neonatal intensive care unit, then the full recovery with no after-effects can be expected.
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