Respiratory Distress Syndrome, Neonatal



  • Neonatal respiratory distress syndrome (NRDS) is a disorder primarily of prematurity manifested by respiratory distress. However, it can occur in early term neonates as well.
  • 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: male predominance
  • Eighth leading cause of infant death in the United States in 2021: 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
  • Low birth weight
  • Infants of diabetic mothers
  • Infants of hypertensive mothers
  • Perinatal asphyxia
  • History of RDS in a sibling
  • Cesarean delivery or operative vaginal delivery
  • Assisted reproductive technology
  • Lack of prenatal care

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 babies born between 24 weeks’ and 31 6/7 weeks, gestational age, antenatal corticosteroid use when administered 2 to 7 days prior decreased the risk of NRDS, surfactant use, and death.
    • For women at risk for preterm delivery within 24 0/7 and 33 6/7, weeks’ gestation, including those with ruptured membranes and multiple gestations

Commonly Associated Conditions

  • Patent ductus arteriosus (PDA)
  • Bronchopulmonary dysplasia (BPD)
  • Pneumothorax
  • Recurrent wheezing, asthma, respiratory infections, and PFT abnormalities

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