Why is my baby having trouble breathing?
Babies breathe to move air in and out of their bodies. The lungs
move oxygen from the air into the blood through tiny sacs called
alveoli.The alveoli expand when a baby breathes in. They get
smaller when a baby breathes out.
The lungs make a substance called surfactant
(sur-FAK-tant) to help keep the alveoli from collapsing
when a baby breathes out. If the alveoli
collapse, the baby has to work much harder
to open them back up with the next breath.
What is respiratory distress syndrome?
Respiratory distress syndrome, or RDS, may
occur when a baby does not make enough surfactant.
Babies with RDS work hard to breathe every
time they take a breath.
RDS symptoms most often occur within the
first minutes to a few hours after birth.
They may include:
• Rapid, shallow breathing
• Grunting sounds when breathing out
• Flaring of the nostrils when breathing in
• Brief stop in breathing (apnea)
• Sharp pulling in of the chest muscles
during breathing (retraction)

What causes RDS?
The main factor of RDS is prematurity. When
babies are born early, their lungs are not fully
developed. These babies need help breathing
until they are able to make enough lung
surfactant on their own.
How common is RDS?
RDS affects about 1 in every 10 premature babies born in the U.S. It is most common in babies
born 6 weeks or more before their due dates, but can occur in babies of any age. Almost all
premature babies born before 28 weeks of pregnancy have RDS.

What treatment will my baby receive?
Treatment will depend on how much help your baby needs to
breathe. Possible treatments include:
• Surfactant – a medicine that helps keep the alveoli open
so that oxygen can be used
• Extra oxygen – given by nasal cannula (nose tube) or mask:
– CPAP (continuous positive airway pressure) – a
treatment that uses mild pressurized air to keep
the lungs open
– Mechanical ventilator (in rare cases) – a machine that
helps your baby breathe using a tube
• Antibiotics – medicines that fight infections

How will I know how my baby is doing?
Your health care team will keep you up-to-date on your baby.
They have several ways to measure breathing and lung
health, including:
• Vital signs and lab tests
• Settings on the mechanical ventilator – level of
breathing support
• Oxygenation index – a formula that the health care team
uses to measure how well the baby’s lungs are working

What will happen next?
Most babies respond well to treatment for RDS. Treatment
will continue until the baby’s lungs develop and can make
enough surfactant. How long this takes depends on how early
the baby was born. Talk to the health care team. They can
answer any questions you have about your baby.

Glossary
Alveoli – tiny sacs in the lungs
that move oxygen from the air
into the blood
Antibiotics – medicines that fight
infections caused by bacteria
Apnea – a brief stop in breathing
CPAP (continuous positive airway
pressure) – a treatment that uses
mild pressurized air to keep the
lungs open
Mechanical ventilator – a machine
that helps your baby breathe by
moving air in and out of the lungs
Oxygenation index – formula the
health care team uses to measure
how well the baby’s lungs are working
RDS (respiratory distress
syndrome) – when a baby’s lungs
do not make enough surfactant.
This makes it hard to breathe
Retraction – Sharp pulling in of the
chest muscles during breathing
Surfactant – a substance that
helps keep the alveoli open so
that oxygen can be used
Ask the health care team when
you have questions—they are
there to help.

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