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Respiratory Distress Syndrome

Respiratory distress syndrome is a lung disorder in preterm infants (and, occasionally, in full-term infants) that causes increasing difficulty breathing, which can lead to a life-threatening deficiency of oxygen in the blood. A prolonged lack of oxygen in the blood may permanently damage the baby’s brain or lungs. The more premature a baby is, the greater the risk of respiratory distress syndrome. The disorder occurs frequently in babies who weigh less than 3 pounds at birth and also is common in infants whose mothers have diabetes (see page 889).

After a baby’s first breath has caused his or her lungs to expand, the alveoli (tiny air sacs in the lungs) are kept open by a natural chemical in the lungs called surfactant. Keeping the alveoli open is essential for breathing, because oxygen passes into the bloodstream and carbon dioxide enters the lungs to be exhaled through the capillaries (small blood vessels) that surround the alveoli. In babies with respiratory distress syndrome, however, the lungs do not contain enough surfactant, and the alveoli start to close again within minutes or hours after birth, leading to increasing difficulty breathing and inadequate exchange of oxygen and carbon dioxide.

Symptoms

In respiratory distress syndrome, a baby’s breathing gradually becomes more and more labored and rapid in the first few hours after birth. As the baby breathes in, his or her chest sinks (rather than expands, as it normally would). When breathing out, the baby grunts.

Diagnosis

A diagnosis of respiratory distress syndrome is based on the baby’s symptoms and the amount of surfactant in the baby’s lungs. In some cases, a doctor may be able to determine the amount of surfactant in a fetus’s lungs before delivery by performing amniocentesis (see page 510). If the amount of surfactant appears to be inadequate, it may be increased by giving the pregnant woman an injection of a corticosteroid medication, which stimulates the production of surfactant in the fetus’s lungs.

Treatment

A baby who has respiratory distress syndrome or who is at risk of developing it is treated in a hospital neonatal intensive care unit (ICU). Treatment includes placing an inhaler over the baby’s face to administer artificial surfactant to open the alveoli and help restore normal breathing. The infant also may be given artificial respiration, in which a tube is threaded into his or her trachea (windpipe) to deliver oxygen to the lungs. The baby’s blood will be continuously monitored to determine the levels of oxygen, carbon dioxide, and other body chemicals, including bicarbonate, sodium, potassium, and chloride. After treatment with artificial surfactant, infants who are very premature (born before the 28th week of pregnancy) or who are very small (about 3 pounds or less) remain at risk for respiratory distress syndrome and must be closely monitored in a neonatal ICU for signs of breathing problems.

Respiratory distress syndrome

The alveoli produce a substance called surfactant, which normally coats and protects the alveoli and enables them to stay open (left) so they can absorb oxygen from inhaled air. Without surfactant, an alveolus collapses (right), causing the labored breathing that is characteristic of respiratory distress syndrome.

Neonatal Jaundice

Neonatal jaundice is yellowing of an infant’s skin and the whites of the eyes that occurs soon after birth. The condition is caused by an excess of bilirubin (a waste product of the normal breakdown of red blood cells) in the blood. Normally, bilirubin is removed from the blood by the liver. In a newborn, jaundice usually occurs because the liver is not yet fully developed and cannot process the bilirubin fast enough. This type of neonatal jaundice is called physiological jaundice and occurs in more than half of all newborns.

An uncommon form of neonatal jaundice, called hemolytic jaundice, can result from a condition called Rhesus (Rh) incompatibility (see page 508), in which antibodies (infection-fighting