Respiratory distress

1. Respiratory Distress

What is it?

This is a very common reason for a baby to be admitted to the NICU. After birth, the baby, for some reason, has problems with breathing. This may show up in one or more of these ways:

  • Breathing that is too fast and/or breathing hard

  • A slight 'grunting' noise when baby breathes out

  • Baby may be slightly blue in colour

  • The nostrils may flare when baby breathes

  • Baby may look like s/he is sucking a breath in

Why does this happen?

There are a number of reasons:

  • Infection - (usually pneumonia) may be acquired before, during or after birth

  • Meconium exposure - the first baby stool passed before birth and inhaled into baby's lungs.

  • 'Transient tachypnoea' (breathing too fast which resolves usually within 24 hours) - this is usually caused by excessive fluid being retained in the lungs after birth and is most common after caesarean sections

  • Respiratory Distress Syndrome - see next section

  • Pneumothorax (air leak) is very uncommon - caused when some of the alveoli (air spaces in the lung) rupture and allow air to escape through the lung and into the chest


Sometimes no treatment is needed and the baby only needs to be watched closely. However we may need to use any or all of the following treatments if the baby needs them:

  • Chest x-ray to help us see what is wrong

  • Blood tests - usually done from a small heel prick but sometimes from a vein

  • Oxygen may be required. This is usually given with CPAP (Consistent Positive Airway Pressure) or ventilation

  • Antibiotics if infection is suspected

  • IV Fluids (drip) may be needed if baby is unable to suck and swallow feeds due to the fast breathing rate or increased work of breathing

  • Assistance with breathing (CPAP) may be required. This is a method of keeping the baby's lungs slightly inflated with air or oxygen but the baby breathes for her/himself

  • Occasionally ventilation may be required where a machine helps baby with the work of breathing. The baby may have leads connecting him or her to machines that check the heart rate, breathing rate and level of oxygen in the blood.

2. Respiratory Distress Syndrome (RDS)

This almost always occurs only with prematurity and generally the less mature a baby the more common and more severe the syndrome is. It is not a disease. It is a result of a lack of substance called surfactant which is present in the lungs of mature babies (over 36 weeks) and is necessary for maintaining expansion of lungs (breathing). Babies over 32 weeks gestation usually do not have severe RDS.


As for Respiratory Distress above.

In addition, a small amount of artificial surfactant may be placed into the baby's lungs to help the lungs expand and contract more easily.

Length of Stay

This depends mostly on gestational age and partly on the severity of the syndrome. Some very preterm babies go on to develop a long term oxygen requirement and few may go home still requiring oxygen.

If you have concerns or want more information about your baby, ask the doctor or nurse providing your baby's care.