Breathless Beginnings: Understanding Newborn Respiratory Distress Syndrome and How to Protect Your Baby

Published by Health Professional

on Tuesday, April 4th 2023

Children Health

Newborn respiratory distress syndrome (NRDS) happens when a baby’s lungs are not fully developed and cannot provide enough oxygen, causing breathing difficulties. It usually affects premature babies.

It’s also known as infant respiratory distress syndrome, hyaline membrane disease, or surfactant deficiency lung disease.

Despite having a similar name, NRDS is unrelated to acute respiratory distress syndrome (ARDS).

Why it happens

NRDS usually occurs when the baby’s lungs have not produced enough surfactant.

This substance, made up of proteins and fats, helps keep the lungs inflated and prevents them from collapsing.

A baby normally begins producing surfactant between weeks 24 and 28 of pregnancy.

Most babies produce enough to breathe normally by week 34.

If your baby is born prematurely, it may not have enough surfactant in their lungs.

Occasionally, NRDS affects babies that are not born prematurely.

For example, when:

  • the mother has diabetes
  • the baby is underweight
  • the baby’s lungs have not developed properly

Around half of all babies born between 28 and 32 weeks of pregnancy develop NRDS.

In recent years the number of premature babies born with NRDS has been reduced with steroid injections, which can be given to mothers during premature labor.

Symptoms of NRDS

The symptoms of NRDS are often noticeable immediately after birth and get worse over the following few days.

They can include:

  • blue-colored lips, fingers, and toes
  • rapid, shallow breathing
  • flaring nostrils
  • a grunting sound when breathing

If you’re not in the hospital when you give birth and notice the symptoms of NRDS in your baby, call 911 immediately and ask for an ambulance.

Diagnosing NRDS

A number of tests can be used to diagnose NRDS and rule out other possible causes.

These include:

  • a physical examination
  • blood tests to measure the amount of oxygen in the baby’s blood and check for an infection
  • a pulse oximetry test to measure how much oxygen is in the baby’s blood using a sensor attached to their fingertip, ear, or toe
  • a chest X-ray to look for the distinctive cloudy appearance of the lungs in NRDS

Treating NRDS

The main aim of treatment for NRDS is to help the baby breathe.

Treatment before birth

If you’re thought to be at risk of giving birth before week 34 of pregnancy, treatment for NRDS can begin before birth.

You may have a steroid injection before your baby is delivered. A second dose is usually given 24 hours after the first.

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.

You may also be offered magnesium sulfate to reduce the risk of developmental problems linked to being born early.

If you take magnesium sulfate for more than 5 to 7 days or several times during your pregnancy, your newborn baby may be offered extra checks. This is because prolonged use of magnesium sulfate in pregnancy has, in rare cases, been linked to bone problems in newborn babies.

Treatment after the birth

Your baby may be transferred to a ward that provides specialist care for premature babies (a neonatal unit).

If the symptoms are mild, they may only need extra oxygen. It’s usually given through an incubator, a small mask over their nose or face, or tubes into their nose.

If symptoms are more severe, your baby will be attached to a breathing machine (ventilator) to either support or take over their breathing.

These treatments are often started immediately in the delivery room before transfer to the neonatal unit.

Your baby may also be given a dose of artificial surfactant, usually through a breathing tube.

Evidence suggests early treatment within 2 hours of delivery is more beneficial than if treatment is delayed.

They’ll also be given fluids and nutrition through a tube connected to a vein.

Some babies with NRDS only need help with breathing for a few days. But some, usually those born extremely prematurely, may need support for weeks or months.

Premature babies often have multiple problems keeping them in the hospital, but generally, they’re well enough to go home around their expected delivery date.

The length of time your baby needs to stay in the hospital will depend on how early they were born.

Complications of NRDS

Most babies with NRDS can be successfully treated, although they risk developing further problems later in life.

Air leaks

Air can sometimes leak out of the baby’s lungs and become trapped in the chest cavity. This is known as pneumothorax.

The air pocket places extra pressure on the lungs, causing them to collapse and leading to additional breathing problems.

Air leaks can be treated by inserting a tube into the chest to allow the trapped air to escape.

Internal bleeding

Babies with NRDS may have bleeding inside their lungs (pulmonary hemorrhage) and brain (cerebral hemorrhage).

Bleeding in the lungs is treated with air pressure from a ventilator to stop the bleeding and a blood transfusion.

Bleeding into the brain is quite common in premature babies, but most bleeds are mild and do not cause long-term problems.

Lung scarring

Sometimes ventilation (begun within 24 hours of birth) or the surfactant used to treat NRDS causes scarring to the baby’s lungs, which affects their development.

This lung scarring is called bronchopulmonary dysplasia (BPD).

Symptoms of BPD include rapid, shallow breathing and shortness of breath.

Babies with severe BPD usually need additional oxygen from tubes into their noses to help their breathing.

This usually stops after a few months when the lungs have healed.

But children with BPD may need regular medicine, such as bronchodilators, to help widen their airways and make breathing easier.

Developmental disabilities

Suppose the baby’s brain is damaged during NRDS because of bleeding or a lack of oxygen. In that case, it can lead to long-term developmental disabilities, such as learning difficulties, movement problems, impaired hearing, and impaired vision.

But these developmental problems are not usually severe. For example, 1 survey estimated that 3 out of 4 children with developmental problems only have a mild disability, which should not stop them from leading a normal adult life.


In conclusion, Newborn Respiratory Distress Syndrome (NRDS) is a serious condition affecting many premature babies but can also occur in full-term infants. The condition is caused by a lack of lung surfactant, leading to severe breathing difficulties and even death if left untreated. 

Fortunately, with modern medical interventions and treatments, the prognosis for babies with NRDS has significantly improved. Treatments such as surfactant replacement therapy, mechanical ventilation, and oxygen therapy have been proven effective in managing NRDS and improving the affected infants’ outcomes. 

However, prevention is still the best approach to NRDS, and steps should be taken to ensure that pregnant women receive adequate prenatal care and that premature births are minimized. 

Overall, NRDS remains a significant challenge for healthcare professionals and requires ongoing research and intervention to improve outcomes for affected infants.

Five frequently asked questions about Newborn Respiratory Distress Syndrome (NRDS):

What is NRDS?
  1. NRDS is a condition that affects newborn babies, especially premature babies, where they experience breathing difficulties due to a lack of surfactant in their lungs.
What causes NRDS?
  1. NRDS is caused by a lack of surfactant, a substance that helps keep the air sacs in the lungs open, making it easier for babies to breathe. This lack of surfactant is more common in premature babies who have not yet had the chance to develop enough of it.
What are the symptoms of NRDS?
  1. The symptoms of NRDS can vary but generally include rapid or shallow breathing. Grunting sounds when breathing, flaring of the nostrils, and a bluish tint to the skin (cyanosis). These symptoms may appear shortly after birth or develop for a few hours or days.
How is NRDS treated?
  1. NRDS is typically treated with surfactant replacement therapy, which involves administering a synthetic version of the surfactant missing in the baby’s lungs. Mechanical ventilation and oxygen therapy may also help the baby breathe.
Can NRDS be prevented?
  1. While there is no surefire way to prevent NRDS, some steps can be taken to reduce its risk. These include adequate prenatal care for pregnant women, avoiding early labor induction, and using steroid medications to help the baby’s lungs mature before birth.