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Neonatal respiratory distress syndrome

Last updated: May 11, 2021

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Neonatal respiratory distress syndrome (NRDS), or surfactant deficiency disorder, is a lung disorder in infants that is caused by a deficiency of pulmonary surfactant. It is most common in preterm infants, with the incidence and severity decreasing with gestational age. Surfactant deficiency causes the alveoli to collapse, resulting in impaired blood gas exchange. Symptoms manifest shortly after birth and include tachypnea, tachycardia, increased breathing effort, and/or cyanosis. The suspected diagnosis is based on clinical features and confirmed by evaluating the extent of atelectasis via chest x-ray. Blood gases show respiratory and metabolic acidosis in addition to hypoxia. Treatment primarily involves emergent resuscitative measures, including nasal continuous positive airway pressure (CPAP) and stabilizing blood sugar levels and electrolytes. In addition, intratracheal surfactant is administered if ventilation alone is unsuccessful. Most cases resolve within 3–5 days of treatment. However, complications such as hypoxemia, tension pneumothorax, bronchopulmonary dysplasia, sepsis, and neonatal death may still occur. NRDS can be prevented by administering antenatal glucocorticoids to the mother if premature delivery is expected.



Epidemiological data refers to the US, unless otherwise specified.


  • History of premature birth
  • Onset of symptoms: usually immediately after birth but can occur within 48–72 hours postpartum
  • Signs of increased breathing effort
    • Tachypnea
    • Nasal flaring and moderate to severe subcostal/intercostal and jugular retractions
  • Typical expiratory “grunting”
  • Auscultation: decreased breath sounds
  • Cyanosis due to pulmonary hypoxic vasoconstriction



Neonatal respiratory distress syndrome

Transient tachypnea of the newborn (wet lung disease) [10] Persistent pulmonary hypertension of the newborn (PPHN) [11] Meconium aspiration syndrome [12][13][14]
  • Delayed resorption of fetal lung fluid
Risk factors
Onset of symptoms
  • Within the first minutes/hours after birth
  • Immediately after birth and within the next 2 hours
  • Within 24 hours after birth
  • Immediately after birth
Clinical features
  • Supportive care
  • Administration of artificial surfactant
  • Resolves without complications in the majority of cases
  • Severe PPHN
    • Developmental delay
    • Motor deficit
    • Hearing deficit

The differential diagnoses listed here are not exhaustive.

Physiologic O2 saturation in neonates is around 90% instead of 100%. A saturation of 100% is considered toxic for neonates!


Bronchopulmonary dysplasia (BPD)

Further complications

Baby oxen have RIBs: Babys receiving too much oxygen get Retinopathy of prematurity, Intraventricular hemorrhage, and Bronchopulmonary dysplasia.


We list the most important complications. The selection is not exhaustive.

  • Mortality rate: < 10% [20]
  • Most cases that are treated promptly resolve within 3–5 days.


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