Medicines for Newborn respiratory distress syndrome

What it is

Newborn respiratory distress syndrome (NRDS) is a breathing problem that mainly affects premature babies (babies born early), whose lungs are not yet fully developed. It occurs because the baby’s lungs are lacking enough of a substance called surfactant — a natural substance that lines the tiny air sacs in the lungs and helps keep them open, so that the lungs can inflate and work properly. Surfactant is produced later in pregnancy, so babies born prematurely (particularly very early) may not have enough of it, which means their lungs are stiff and tend to collapse, making it hard for the baby to breathe and to get enough oxygen. The more premature the baby, the higher the risk. NRDS usually appears soon after birth, and the signs are those of a baby having difficulty breathing, which can include: fast breathing, working hard to breathe (with the chest or ribs being drawn in), grunting when breathing out, flaring of the nostrils, and, if the baby is not getting enough oxygen, a bluish tinge to the skin (particularly the lips and tongue). NRDS is a serious condition that needs prompt specialist care, but it is a well-recognised condition of prematurity, and modern neonatal (newborn) care for it is very effective. Care is provided in a neonatal unit and includes support for the baby’s breathing and, importantly, treatment with surfactant given directly into the baby’s lungs, which replaces the missing substance and greatly helps the lungs to work — this treatment has significantly improved outcomes. In addition, there is an important preventive measure: when a premature birth is expected or threatened, giving the mother steroid medicine before the birth (antenatal steroids) helps the baby’s lungs to mature and produce more surfactant, which reduces the risk and severity of NRDS. With modern care, most babies with NRDS recover well as their lungs mature. The key messages are that NRDS is a breathing problem mainly affecting premature babies whose lungs lack surfactant, that it needs specialist neonatal care (including breathing support and surfactant treatment, which are very effective), and that antenatal steroids given before a premature birth help prevent or reduce it.

How it is treated

Newborn respiratory distress syndrome is managed in a neonatal unit with breathing support and surfactant treatment, which are very effective, and is often prevented or reduced by giving antenatal steroids before a premature birth; most babies recover well as their lungs mature. Prevention and preparation are important where a premature birth is expected: when a premature birth is threatened or planned, giving the mother steroid medicine (antenatal corticosteroids) before the birth helps the baby’s lungs to mature and produce more surfactant, which reduces the risk and severity of NRDS — this is a key and effective preventive measure. After birth, a premature baby with NRDS (or at risk of it) is cared for in a neonatal unit by specialists, and treatment is tailored to the baby’s needs. The mainstays are: supporting the baby’s breathing — this can range from providing extra oxygen and gentle breathing support (such as CPAP, which helps keep the baby’s airways and lungs open), to, for more significant NRDS, more support including a ventilator (breathing machine) to help or take over breathing, as needed; and surfactant replacement treatment — giving surfactant (the missing substance) directly into the baby’s lungs (through a tube), which replaces what the lungs are lacking, helps the air sacs stay open, and greatly improves lung function; this treatment has been a major advance and significantly improves outcomes. Alongside these, the baby receives supportive neonatal care — such as maintaining warmth, careful management of fluids and nutrition, monitoring, and treating any other problems of prematurity or complications — as premature babies often have other needs. The level and duration of support depend on how premature the baby is and the severity of the NRDS. As the baby’s lungs mature and produce their own surfactant over the following days, the NRDS usually improves, and the breathing support is gradually reduced as the baby is able to breathe more independently. With modern neonatal care — antenatal steroids, breathing support, and surfactant treatment — most babies with NRDS recover well, though very premature babies may have a longer course and other needs. Support for the family, who are cared for alongside their baby in the neonatal unit, is an important part of care. The reassuring messages are that NRDS is a well-recognised condition of prematurity, that modern neonatal care for it — breathing support and surfactant treatment — is very effective and has greatly improved outcomes, that antenatal steroids given before a premature birth help prevent or reduce it, and that most babies recover well as their lungs mature; so specialist neonatal care, surfactant treatment, and antenatal steroids where a premature birth is expected are the keys to managing NRDS.