Fact #1: Premature babies are at the highest risk due to underdeveloped lungs

Neonatal Respiratory Distress Syndrome (NRDS) is one of the most common and serious breathing disorders in newborns, especially in premature babies. It occurs when a newborn’s lungs are not fully developed and lack a critical substance called surfactant, which helps keep the air sacs open for normal breathing.

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A Closeup of a hand of a premature newborn baby in incubator

🚨 Why Are Premature Babies at the Highest Risk?

The lungs begin developing early in pregnancy, but they are not fully mature until around 36-37 weeks of gestation. Babies born before 34 weeks have a high risk of NRDS because their lungs do not produce enough surfactant.

Here’s why surfactant is crucial:

🔹 The Role of Surfactant in Breathing

✔ In a healthy newborn, surfactant coats the tiny air sacs (alveoli) in the lungs, preventing them from collapsing after each breath.
✔ Without surfactant, the alveoli collapse, making it difficult for the baby to take in oxygen and remove carbon dioxide.

💡 Fact: The more premature a baby is, the less surfactant their lungs produce, increasing their risk of NRDS.

🗂️ Risk Levels Based on Prematurity

  • 👶 Extremely Preterm (Before 28 Weeks): High risk – Lungs are severely underdeveloped, and surfactant production is minimal.
  • 👶 Very Preterm (28-32 Weeks): Moderate to high risk – Some surfactant may be present, but not enough for proper lung function.
  • 👶 Late Preterm (32-36 Weeks): Lower risk – Surfactant production increases significantly after 34 weeks.
  • 👶 Full-Term (37+ Weeks): Very low risk – Lungs are typically fully developed, though some babies may still develop NRDS due to other factors.

🩺 Symptoms of NRDS in Premature Babies

Signs of NRDS usually appear within minutes to hours after birth and include:

Rapid, shallow breathing (Tachypnea)
Grunting sounds when exhaling
Nasal flaring (widening of the nostrils)
Retractions (chest muscles pulling in with each breath)
Bluish skin (Cyanosis) due to low oxygen levels

Without medical intervention, NRDS can quickly worsen, leading to severe oxygen deprivation and complications.


📊 How Common Is NRDS in Premature Babies?

  • Affects 50-60% of babies born before 28 weeks
  • Affects 25% of babies born at 30-32 weeks
  • Affects <5% of babies born after 34 weeks

This direct link between prematurity and NRDS is why doctors closely monitor and prepare for respiratory support in preterm deliveries.


💡 Can NRDS Be Prevented?

Yes! Medical advances have significantly reduced NRDS risks in preterm babies. Here’s how:

Prenatal Steroid Injections: Given to mothers at risk of preterm birth to boost lung maturity.
Surfactant Replacement Therapy: Administered immediately after birth to help preterm babies breathe.
Respiratory Support (CPAP or Mechanical Ventilation): Ensures oxygen delivery to underdeveloped lungs.


📌 Final Thoughts

Premature babies face the highest risk of Neonatal Respiratory Distress Syndrome because their lungs are underdeveloped and lack surfactant. The earlier a baby is born, the greater the risk, but advances in neonatal medicine have significantly improved survival rates.

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