Respiratory Distress Syndrome, Neonatal



  • Neonatal respiratory distress syndrome (NRDS) is a disorder primarily of prematurity manifest by respiratory distress.
  • System(s) affected: respiratory
  • Synonym(s): hyaline membrane disease; surfactant deficiency
A disorder of the neonatal period



  • >90% incidence in infants born ≤28 weeks’ gestation
  • 1% all newborns, 10% of preterm infants
  • Inversely proportional to gestational age
  • Gender: slight male predominance
  • Eighth leading cause of infant death in United States in 2019: 11.3 infant deaths per 100,000 live births (1)

Etiology and Pathophysiology

  • Impaired surfactant synthesis and secretion
    • Usually secondary to deficient surfactant (dipalmitoyl lecithin) production in immature lungs
    • Leads to low lung compliance, low lung volume, and increased lung resistance
  • High oxygen exposure and barotrauma during treatment can cause further damage to alveolar epithelium.

No known genetic pattern

Risk Factors

  • Premature birth
  • Infants of diabetic mothers
  • Perinatal asphyxia
  • History of RDS in a sibling
  • Cesarean delivery

General Prevention

  • Prevention of premature birth:
    • Education
    • Regular prenatal care
    • Management of maternal medical conditions
  • Promote healthy behaviors during pregnancy focusing on:
    • Diet
    • Exercise
    • Avoidance of exposure to tobacco smoke, alcohol, and illegal drugs
  • Antenatal corticosteroids: for women at risk for preterm delivery within 7 days and are between 24 0/7 and 33 6/7 weeks’ gestation, including those with ruptured membranes and multiple gestations (2)

Commonly Associated Conditions

  • Patent ductus arteriosus
  • Bronchopulmonary dysplasia (BPD)
  • Pneumothorax

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