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American Lung Association State of Lung Disease in Diverse Communities 2010 73

Respiratory DistressSyndrome (RDS)Respiratory distress syndrome (RDS) is a life-threatening lung

disorder that occurs in premature infants whose lungs have not

fully developed RDS is caused by a lack of pulmonary surfactant a

liquid that coats the inside of the lung This liquid keeps the air sacs

in mature lungs from collapsing and allows them to inflate with air

more easily In a few cases RDS can be caused by genetic problems

with lung development

The incidence of RDS correlates with the amount of time a child staysin the womb1 Most cases are seen in babies born before 28 weeks andit is rare in infants born full-term (at 40 weeks) In 2005 16268 infantssuffered from RDS an incidence rate of 39 per 10002 The RDS incidencerate was 39 per 1000 for Caucasians 47 per 1000 for African Americans18 per 1000 for Hispanics 53 per 1000 for American IndiansAlaskaNatives and 24 per 1000 for Asian AmericansPacific Islanders3

Symptoms usually appear shortly after birth and become more severeover time The symptoms of RDS include bluish color of the skin andmucus membranes brief stopping in breathing grunting nasal flaringdecreased urine output swollen arms and legs rapid and shallow

breathing4

Prematurity is the most important risk factor for developingRDS Other risk factors include a sibling with RDS diabetes in themother Cesarean delivery delivery complications that lead to acidosisin the newborn at birth multiple pregnancy and rapid labor5 RDSinfants may develop several complications including infection of thebloodstream (sepsis) and other problems related to premature birthsuch as bleeding into the brain These and other complications cancause convulsions (shock-like states) and in some cases even death

Prompt treatment is necessary for infants suffering from RDSMechanical ventilation and surfactant therapy have become thestandard of care in management of RDS6 Another effective treatment

is the use of nasal continuous positive airway pressure (nCPAP) NCPAPdelivers highly pressurized air through the nose and helps to keep theairways open It may even prevent the need for a breathing machine formany babies7

In 1979 RDS was the second-ranking cause of death in infants but dueto the progress made in prenatal care it has dropped to the eighthplace in 2007 In 2007 735 deaths or 170 per 100000 live births weredue to RDS8

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African Americans

In 2005 African American infants had a RDS incidence rateof 47 per 1000 compared with 39 per 1000 for Caucasian

African Americans had the second highest incidence rate of allracialethnic groups after American IndiansAlaska Natives9

In 2007 African American infants (353 per 100000) were more thantwice as likely to die from RDS compared to Caucasian infants (139per 100000) and the general US population (170 per 100000) 10 It ispossible that this difference is due to the higher rate of prematurebirths among African American women According to the 2007 birthdata 138 percent of African American women as opposed to 72percent of Caucasian women delivered low-birthweight babies (under2500 grams)11 In 2007 RDS was the eighth leading cause of deathsamong African American infants under 1 year of age12

Hispanics

In 2005 1779 Hispanic infants suffered from respiratory distresssyndrome The incidence rate among Hispanics was 18 per 1000and was lower than all other racialethnic groups and the nationalincidence rate (39 per 1000)13

In 2007 124 Hispanic infants died from RDS an infant mortality rateof 117 per 100000 Hispanic mortality rates for respiratory distresssyndrome were lower than that of Whites (139 per 100000) and thegeneral population (170 per 100000) RDS was ranked the tenth leadingcause of death for Hispanic infants under 1 year of age14

As with asthma RDS mortality rates vary among Hispanic subgroupsIn 2001 (latest year data reported) Puerto Rican infants were twice as

likely to die from RDS (434 per 100000) as Mexican (211 per 100000)and Central and South American infants (173 per 100000)15

Asian Americans Pacific Islanders

In 2005 561 Asian AmericansPacific Islanders were affected byrespiratory distress syndrome Asian Americans had the secondlowest incidence rate after Hispanics compared with all other racialethnic groups in the United States (24 per 1000 and 18 per 1000respectively) 16

Reliable incidence and mortality figures for RDS are not available forAsian AmericansPacific Islanders

American Indians Alaska Natives

In 2005 236 American IndiansAlaska Natives were affected byrespiratory distress syndrome American IndiansAlaska Natives hadthe highest incidence rate of RDS (53 per 1000) of all other racial

Racial

Ethnic

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ethnic groups in the United States The national incidence rate of RDS(38 per 1000) was much lower than for American IndiansAlaskaNatives17

Reliable incidence and mortality figures for RDS are not available forAmerican IndiansAlaska Natives

Resources

1 National Heart Lung and Blood Institute What is Respiratory Distress Syndrome September 2009Availableat httpwwwnhlbinihgovhealthdciDiseasesrdsrds_whatishtml

2 Centers for Disease Control and Prevention National Center for Health Statistics VitalStats Available athttpwwwcdcgovnchsVitalStatshtm Accessed January 7 2008

3 National Center for Health Statistics VitalStats Available at httpcdcgovnchsVitalStatshtm AccessedJanuary 7 2008

4 Greene A Medline Plus Medical Encyclopedia Neonatal Respiratory Distress Syndrome September 5 2007Available at httpwwwnlmnihgovmedlineplusencyarticle001563htm Accessed July 28 2009

5 Ibid

6 Ramanathan R Optimal Ventilatory Strategies and Surfactant to Protect the Preterm Lungs Neonatology 200893(4)302-8


8 Centers for Disease Control and Prevention National Center for Health Statistics National Vital StatisticsReports Deaths Preliminary Data for 2007 Volume 58 No 1 August 19 2009

9 National Center for Health Statistics VitalStats Available at httpcdcgovnchsVitalStatshtml AccessedJanuary 7 2008


11 Ibid

12 Ibid



15 Matthews TJ Menacker F MacDorman M Infant Mortality Statistics from the 2001 Period Linked BirthInfantDeath Data Set National Vital Statistics Report Available at httpswwwnberorgperinatal2001docslfrptpdf Accessed April 11 2007


17 Ibid

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African Americans

In 2005 African American infants had a RDS incidence rateof 47 per 1000 compared with 39 per 1000 for Caucasian

African Americans had the second highest incidence rate of allracialethnic groups after American IndiansAlaska Natives9

In 2007 African American infants (353 per 100000) were more thantwice as likely to die from RDS compared to Caucasian infants (139per 100000) and the general US population (170 per 100000) 10 It ispossible that this difference is due to the higher rate of prematurebirths among African American women According to the 2007 birthdata 138 percent of African American women as opposed to 72percent of Caucasian women delivered low-birthweight babies (under2500 grams)11 In 2007 RDS was the eighth leading cause of deathsamong African American infants under 1 year of age12

Hispanics

In 2005 1779 Hispanic infants suffered from respiratory distresssyndrome The incidence rate among Hispanics was 18 per 1000and was lower than all other racialethnic groups and the nationalincidence rate (39 per 1000)13

In 2007 124 Hispanic infants died from RDS an infant mortality rateof 117 per 100000 Hispanic mortality rates for respiratory distresssyndrome were lower than that of Whites (139 per 100000) and thegeneral population (170 per 100000) RDS was ranked the tenth leadingcause of death for Hispanic infants under 1 year of age14

As with asthma RDS mortality rates vary among Hispanic subgroupsIn 2001 (latest year data reported) Puerto Rican infants were twice as

likely to die from RDS (434 per 100000) as Mexican (211 per 100000)and Central and South American infants (173 per 100000)15

Asian Americans Pacific Islanders

In 2005 561 Asian AmericansPacific Islanders were affected byrespiratory distress syndrome Asian Americans had the secondlowest incidence rate after Hispanics compared with all other racialethnic groups in the United States (24 per 1000 and 18 per 1000respectively) 16

Reliable incidence and mortality figures for RDS are not available forAsian AmericansPacific Islanders

American Indians Alaska Natives

In 2005 236 American IndiansAlaska Natives were affected byrespiratory distress syndrome American IndiansAlaska Natives hadthe highest incidence rate of RDS (53 per 1000) of all other racial

Racial

Ethnic

Differences

R E S P I R A

T O R Y

D I S T R E S S

S Y N D R O M

E

( R D S )

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Resources





5 Ibid






11 Ibid

12 Ibid





17 Ibid

RE S P I RAT ORY

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I S T RE S S

S YNDR OME

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Resources





5 Ibid






11 Ibid

12 Ibid





17 Ibid

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