Neonatal Respiratory Distress Syndrome: Symptoms, Causes, and Care
Updated: 2 days ago
Medically reviewed by Dr. Baraa Alnahhal, MD · Last reviewed: October 2026
Quick Answer: Key Facts About Neonatal RDS
Neonatal respiratory distress syndrome (RDS) is a breathing disorder caused by a lack of surfactant in the lungs, mostly affecting preterm infants born before 32 weeks. [1] Signs include fast breathing, grunting, flaring nostrils and cyanosis. [1] Treatment includes surfactant therapy, CPAP and oxygen, and almost all babies survive with modern care. [1] Corticosteroids given during pregnancy reduce risk. [1] [3]
Feature | Details |
Primary Cause | Lack of surfactant in the lungs. [1] |
Most Affected Group | Preterm infants, especially those born before 32 weeks of gestation. [1] |
Key Symptoms | Fast or shallow breathing, grunting, flaring nostrils, chest retractions, and cyanosis. [1] |
Common Treatments | Surfactant therapy, CPAP machines, and extra oxygen. [1] |
Survival | Almost all babies survive where modern healthcare is available, though some have ongoing health conditions. [1] |
Risk Reduction |
What the research says
Steroids given before birth lower the risk of RDS. A Cochrane review of 27 trials (11,272 women) found that antenatal corticosteroids reduced RDS in newborns by about 29% (risk ratio 0.71, 95% CI 0.65–0.78; 26 studies, 11,183 infants), and also reduced neonatal death (RR 0.78, 95% CI 0.70–0.87). (McGoldrick et al., Cochrane Database of Systematic Reviews, 2020 [3])
CPAP lowers treatment failure and death, with a higher chance of air leak. In 5 trials of 322 preterm infants with respiratory distress, CPAP cut treatment failure (death or need for assisted ventilation) (RR 0.64, 95% CI 0.50–0.82) and overall mortality (RR 0.53, 95% CI 0.34–0.83), but raised the risk of pneumothorax (RR 2.48, 95% CI 1.16–5.30). Three of the five trials dated from the 1970s, so how closely they match current practice is uncertain. (Ho et al., Cochrane Database of Systematic Reviews, 2020 [4])
Surfactant therapy substantially reduces death and breathing complications in preterm infants. The American Academy of Pediatrics clinical report also notes that surfactant deficiency contributes to breathing problems in late-preterm and term newborns with conditions such as meconium aspiration or pneumonia. (Polin & Carlo, Pediatrics, 2014 [2])
What is Neonatal Respiratory Distress Syndrome?
Neonatal respiratory distress syndrome (RDS) is a condition that occurs when a newborn's lungs are not fully developed, making it difficult for them to breathe independently. The core issue lies in the air sacs, known as alveoli, which cannot open fully to allow oxygen into the bloodstream. [1] This condition is primarily driven by a deficiency in surfactant, a slippery, soap-like substance that reduces surface tension and prevents the air sacs from collapsing after each breath.
While RDS is most frequently associated with premature birth, particularly in babies born before 32 weeks, it is a treatable condition. Modern neonatal intensive care units (NICUs) are equipped with specialized technology and therapies designed to support a baby's breathing until their lungs can produce enough surfactant on their own.
What are the symptoms of neonatal respiratory distress syndrome in newborns?
Signs of RDS are typically evident within the first few hours after birth. [1] Medical teams monitor newborns closely for these specific respiratory indicators.
Visual and Audible Signs
Rapid or Shallow Breathing: The infant may breathe much faster than normal or take very small, ineffective breaths. [1]
Apnea: Short pauses in breathing that can be intermittent or prolonged.
Grunting: A distinct sound made when the baby tries to keep air in their lungs.
Nasal Flaring: The nostrils widen significantly with each breath as the baby struggles to pull in more air. [1]
Chest Retractions: The skin pulls in sharply between the ribs or at the base of the throat during inhalation.
Physical Discoloration
Infants with RDS may exhibit cyanosis, which is a bluish or greyish tint to the skin, lips, or fingernails. [1] This is a direct sign that the blood is not receiving enough oxygen from the lungs.
What causes neonatal respiratory distress syndrome, and who is at risk?
The development of RDS depends largely on the timing of lung maturation during pregnancy.
The Role of Surfactant
Surfactant production develops during the third trimester of pregnancy. [1] Because premature babies are born before this process is complete, their lungs lack the surfactant needed to stay open. [1] In rare cases, full-term babies (39 weeks or later) can develop RDS due to factors like a mother's high blood sugar during pregnancy, pneumonia, birth complications, or genetic changes. [1]
Who is at Higher Risk?
Preterm Birth: The earlier the birth, the higher the risk. RDS is most common before 32 weeks, but not uncommon after 32 weeks and before term. [1]
Maternal Health: Mothers with diabetes during pregnancy have a higher chance of having a baby with RDS. [1]
Multiple Births: Twins, triplets, and other multiples are at increased risk. [1]
Family History: A biological sibling who previously had RDS increases the risk for subsequent children. [1]
How is neonatal respiratory distress syndrome diagnosed and treated?
Diagnosis begins with a health check immediately following birth, followed by specialized testing to confirm the condition.
Diagnostic Tools
Imaging: Chest X-rays and other imaging are used to look at the lungs and check for signs of RDS, such as a characteristic "ground glass" appearance.
Blood Gases: Blood tests measure the levels of oxygen and carbon dioxide in the baby's blood to determine how well the lungs are functioning. [1]
Advanced Care in the NICU
Treatment is focused on providing the lungs with what they lack and supporting the baby's effort to breathe.
Surfactant Therapy: Doctors can administer surfactant directly into the baby's lungs to help keep the air sacs open. [1]
CPAP Machines: Continuous Positive Airway Pressure (CPAP) gently pushes air into the lungs, keeping the airways open without the need for invasive measures.
Mechanical Ventilation: In severe cases, a ventilator may be used to breathe for the baby until they become strong enough to do so themselves. [1]
What are recovery and the long-term outlook for neonatal respiratory distress syndrome?
For most families, the outlook is very positive. In areas with access to modern medical facilities, almost all babies survive RDS, although some have ongoing health conditions. [1]
The Path to Improvement
It is common for a baby's condition to appear to worsen slightly before it begins to improve with treatment. [1] As the lungs mature and respond to therapy, the infant will gradually require less supplemental oxygen and breathing support. [1] How long this takes differs for each baby and depends on the baby's gestational age at birth.
Potential Complications
While survival rates are high, some infants may experience complications such as bleeding in the brain or lungs, air buildup around the lungs (pneumothorax), or long-term lung scarring known as bronchopulmonary dysplasia. [1] Vision issues can also occur, requiring ongoing monitoring by pediatric specialists.
Conclusion
Neonatal RDS is a challenging start for any newborn, but it is a condition that modern medicine is well-prepared to handle. By understanding the symptoms and the importance of surfactant, parents can better navigate the NICU experience. With the support of a dedicated neonatal care team, most babies overcome RDS and reach their developmental milestones.
Take the Next Step
For more resources on newborn care and navigating the NICU, visit Rinnit.com.
Frequently Asked Questions
Is neonatal RDS the same as SIDS?
No. RDS is a lung condition present at birth, while SIDS (Sudden Infant Death Syndrome) is the unexplained death of a seemingly healthy baby, usually during sleep.
Can RDS be prevented before birth?
If your baby is at higher risk, your pregnancy care provider might give you corticosteroids during pregnancy, which can help increase the level of surfactant in the baby's lungs.
How long will my baby be in the NICU?
The stay depends on how early the baby was born and how quickly their lungs mature. Your baby's care team can tell you what to expect.
Will my baby have asthma later in life?
Most babies recover well, but some children have ongoing health conditions. Babies who develop lung scarring (bronchopulmonary dysplasia) may have more sensitive lungs. Ask your pediatric team what to watch for.
Can full-term babies get RDS?
Yes, though it is rare. It can be caused by a mother's high blood sugar during pregnancy, pneumonia, certain birth complications, or genetic changes.
What exactly is surfactant?
Surfactant is a slippery substance that helps keep the tiny air sacs in the lungs open.
Does CPAP hurt the baby?
CPAP is designed to be a gentle way to support breathing. It pushes air into the lungs to keep the airways open, and your baby's care team monitors comfort closely.
Is RDS contagious?
No. It is a developmental condition related to lung maturity, not an infection you can catch.
Can I hold my baby if they have RDS?
Ask your baby's care team. In many NICUs, skin-to-skin "kangaroo care" is encouraged once the baby is stable enough, even if they need breathing support.
Why does my baby look blue?
A bluish or greyish tint (cyanosis) happens when there isn't enough oxygen in the blood. It is a key sign that the baby needs breathing help.
What are "retractions"?
A retraction is when the skin pulls in between the ribs or at the base of the throat because the baby is working hard to pull air into the lungs.
Will my baby need oxygen at home?
Most babies do not, but some who have severe RDS or lung scarring may need supplemental oxygen for a period after discharge. Your care team will advise you.
Is RDS more common in boys or girls?
RDS is generally reported to be slightly more common in male infants.
Can a C-section cause RDS?
Babies born by C-section before 39 weeks may have a slightly higher risk, in part because they do not experience the hormonal changes of labor that help clear fluid from the lungs.
Is there a genetic test for RDS?
Most cases are due to prematurity, but rare genetic causes of surfactant deficiency can be tested for if a baby does not respond to standard treatment.
Related Reading
If you found this guide helpful, explore these related Rinnit.com articles:
Learn more in our guide to Apgar Score: How It's Scored and What Your Baby's Score Means.
References
Cleveland Clinic. Neonatal respiratory distress syndrome. Cleveland Clinic. Last updated September 30, 2025. https://my.clevelandclinic.org/health/diseases/rds-neonatal-respiratory-distress-syndrome
Polin RA, Carlo WA, et al. Surfactant replacement therapy for preterm and term neonates with respiratory distress. Pediatrics. 2014;133(1):156-63. PMID 24379227. https://doi.org/10.1542/peds.2013-3443
McGoldrick E, Stewart F, Parker R, et al. Antenatal corticosteroids for accelerating fetal lung maturation for women at risk of preterm birth. Cochrane Database Syst Rev. 2020;12(12):CD004454. PMID 33368142. https://doi.org/10.1002/14651858.CD004454.pub4
Ho JJ, Subramaniam P, Davis PG. Continuous positive airway pressure (CPAP) for respiratory distress in preterm infants. Cochrane Database Syst Rev. 2020;10(10):CD002271. PMID 33058208. https://doi.org/10.1002/14651858.CD002271.pub3
Medical disclaimer
This article is for general informational purposes only and does not constitute medical advice. Always consult a qualified healthcare professional for diagnosis and treatment decisions.
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