Neonatal respiratory distress syndrome (NRDS) happens when a newborn baby's lungs aren not fully developed and cannot provide enough oxygen. It usually affects premature babies.

NRDS is also known as:

  • hyaline membrane disease
  • infant respiratory distress syndrome
  • newborn respiratory distress syndrome
  • surfactant deficiency lung disease (SDLD)

Despite having a similar name, NRDS is not related to  acute respiratory distress syndrome (ARDS).

Why it happens

NRDS usually occurs when the baby's lungs have not produced enough surfactant.

This substance, made up of proteins and fats, helps keep the lungs inflated and prevents them collapsing.

A baby normally begins producing surfactant sometime between weeks 24 and 28 of pregnancy.

Most babies produce enough to breathe normally by week 34.

If your baby is born prematurely, they may not have enough surfactant in their lungs.

Occasionally, NRDS affects babies that are not born prematurely. 

For example, when:

  • the mother has diabetes
  • the baby is underweight
  • the baby's lungs have not developed properly

Around half of all babies born between 28 weeks and 32 weeks of pregnancy develop NRDS.

Iun recent years the number of premature babies born with NRDS has been reduced with the use of steroid injections, which can be given to mothers during premature labour.

Symptoms of NRDS

The symptoms of NRDS are often noticeable immediately after birth and get worse over the following few days.

They can include:

  • blue-coloured lips, fingers and toes
  • rapid, shallow breathing
  • flaring nostrils
  • a grunting sound when breathing

If you're not in hospital when you give birth and notice the symptoms of NRDS in your baby, call 999 immediately and ask for an ambulance.

Diagnosing NRDS

A number of tests can be used to look for the signs of NRDS and rule out other possible causes.

These tests may include:

  • a physical examination
  • blood tests to measure the amount of oxygen in the blood and check for an infection
  • a pulse oximetry test – to measure how much oxygen is in the baby's blood using a sensor attached to the fingertip, ear or toe
  • a chest X-ray – to look for the distinctive cloudy appearance of NRDS


Treatment of neonatal respiratory distress syndrome (NRDS) aims to support the baby's breathing while treating the underlying cause.

Treatment before birth

If you're thought to be at a risk of giving birth before week 34 of pregnancy, treatment for NRDS can begin before birth. You'll usually be given two injections a day of a steroid medication called betamethasone, starting a few days before the delivery is expected.

Betamethasone helps stimulate the development of the baby’s lungs. It's estimated that the use of betamethasone prevents NRDS occurring in a third of premature births.

Treatment after the birth

If betamethasone isn't used, or if it's unsuccessful in preventing NRDS, it's likely that your baby will be transferred to a neonatal unit.

You baby may only need extra oxygen if the symptoms are mild; it's usually given into an incubator or by nasal tubes. If symptoms are more severe, your baby will be attached to a machine to either support or take over their breathing. These treatments are often started immediately in the delivery room before transfer to the neonatal unit.

Your baby may also be given a dose of artificial surfactant, usually delivered through a breathing tube.

Evidence suggests that early treatment (within two hours of delivery) is more beneficial than if treatment is delayed.

Your baby will also be given fluids and nutrients through a tube connected to one of their veins.

Some babies with NRDS only require help with breathing for a few days, although others – usually those born extremely prematurely – may need support for weeks or even months.

Premature babies often have multiple problems that keep them in hospital, but generally they're well enough to go home around their original expected delivery date. However, the exact length of time your baby needs to stay in hospital largely depends on how early they were born.


Babies who experience neonatal respiratory distress syndrome (NRDS) have a significant risk of developing further problems.

Air leaks

In some cases of NRDS, air can leak out of the lungs and become trapped in the chest cavity. This is known as pneumothorax.

The pocket of air places extra pressure on the lungs, causing them to collapse and leading to additional breathing problems.

Air leaks can be treated by inserting a tube into the chest to allow the trapped air to drain.

Internal bleeding

Babies with NRDS may experience bleeding inside their lungs (pulmonary haemorrhage) and brain (cerebral haemorrhage).

Bleeding into the lungs can be difficult to treat, but usually air pressure from a ventilator and transfusion of blood products allows the bleeding to stop.

Bleeding into the brain is quite common in premature babies, but fortunately most bleeds are mild and there are few longer-term problems. Larger bleeds occasionally require surgery to drain accumulating fluid.

Bronchopulmonary dysplasia

Bronchopulmonary dysplasia (BPD) is a long-term lung condition that can affect some children with NRDS. It develops when the ventilator used to treat NRDS causes scarring to the lungs, which affects their development.

Symptoms of BPD include, rapid, shallow breathing and shortness of breath.

Babies with severe BPD usually require additional oxygen, through tubes into their nose, to help with their breathing. This is usually stopped after a few months, when the lungs have healed.

However, children with BPD may require regular medication, such as bronchodilators, to help widen the airways of their lungs and assist with their breathing.

Developmental disabilities

If the brain is damaged during NRDS, either due to bleeding or a lack of oxygen, it can lead to long-term developmental disabilities, such as learning difficulties, movement problems, impaired hearing and impaired vision.

However, these developmental problems are not usually severe. For example, one survey estimated that three out of four children with developmental problems only have a mild disability, which shouldn't stop them leading a normal adult life.

The information on this page has been adapted by NHS Wales from original content supplied by NHS UK NHS website nhs.uk
Last Updated: 05/05/2021 15:54:42