Nurse's NICU Guide to Respiratory Distress Syndrome

Respiratory Distress Syndrome is one of the more common reasons for a newborn's admission to the NICU. Two of the most commonly seen forms of respiratory distress in newborns are respiratory distress caused by surfactant deficiency and respiratory distress caused by transient tachypnea of the newborn.

Respiratory Distress Syndrome (RDS)

Respiratory Distress Syndrome, or RDS, is a condition in which an infant born prematurely lacks a sufficient amount of surfactant needed for proper lung function. RDS typically affects infants born less than 37 weeks gestation and presents immediately after birth^1,3. RDS can commonly be confused with transient tachypnea of the newborn, or TTN, but they are, in fact, two separate conditions. We will discuss TTN in a moment.

What is Surfactant?

In order to better understand RDS, nurses need to understand the role surfactant plays in lung function. Surfactant is a soapy-like substance produced by Type II pneumocytes within the lungs. The purpose of surfactant is to decrease the surface tension of the alveoli, which in turn decreases the likely hood of the alveoli collapsing. Without a sufficient amount of surfactant, lung compliance is decreased, resulting in increased work of breathing in the newborn¹.

Signs and Symptoms of RDS ^1,3

• Tachypnea (Normal respiratory rate for a newborn is 40-60 breaths per minute)
• Grunting
• Nasal flaring
• Retractions
• Cyanosis
• Apnea or irregular breathing
• Poor feeding
• Hypoglycemia
• Hypothermia

Diagnosing RDS

The main tool used in diagnosing RDS is a chest x-ray. Chest x-rays help providers to differentiate between RDS and TTN. In an infant with RDS, the chest x-ray will show a ground glass appearance with poorly expanded lung fields¹.

Blood gases are typically drawn, and they can show low oxygen levels and high carbon dioxide levels in the infant's blood. Since sepsis can be a contributing factor in the development of RDS, blood cultures and a complete blood count are drawn to evaluate the need for antibiotic therapy¹. 

Treatment for RDS ^1,3

• CPAP
• High Flow Nasal Cannula
• Ventilator Support
• Surfactant administration
• Intravenous fluids to maintain appropriate blood glucose level

Complications of RDS

Monitoring for complications of RDS is an important role every NICU nurse needs to perform. Complicates of RDS include¹:

• Intraventricular Hemorrhage
• Tension Pneumothorax
• Broncho-pulmonary dysplasia
• Death

Transient Tachypnea of the Newborn (TTN)

Transient tachypnea of the newborn, or TTN, differs from RDS in one key element. Transient tachypnea is caused by fluid that remains in the newborn's lungs following delivery. It typically affects term infants, large for gestational age infants, and infants born by cesarean delivery without labor². While RDS presents immediately after birth, TTN can present up to 2 hours after delivery³.

Signs and Symptoms of TTN ^2,3

• Tachypnea
• Grunting
• Retractions
• Rale and rhonchi breath sounds
• Nasal flaring
• Cyanosis

Diagnosing TTN

While TTN and RDS present in much the same way, diagnosing between the two conditions comes down to a chest x-ray. Remember, the chest x-ray in an infant with RDS will show a ground-glass appearance with poorly expanded lung fields¹. However, the chest x-ray in an infant with TTN will show normal or overly inflated lung fields with a bilateral fluffy appearance. It will also show fluid that is remaining in the lung fissures^2,3. Sepsis can be a contributing factor in TTN, so a blood culture and CBC are drawn².

Treatment for TTN

Treatment for TTN is supportive, with the most common form of support being respiratory. The most used form of respiratory support is CPAP support, with ventilatory support rarely needed². TTN resolves quickly, typically within 72 hours. One of the biggest indicators for predicting how long TTN will last is the infant's beginning respiratory rate. The higher the initial respiratory rate, the longer the nurse can expect the TTN to last³.

Final Thoughts

Caring for a newborn in respiratory distress can feel daunting for many new NICU nurses, but it doesn't have to be. This guide will help any new NICU nurse feel more confident and less intimidated when faced with caring for a newborn in respiratory distress.

References/Resources

Respiratory Distress Syndrome in Neonates: Merck Manual Professional Version

Transient Tachypnea of the Newborn: Merck Manual Professional Version

Newborn Respiratory Distress: American Academy of Family Physicians