What Is Respiratory Distress Syndrome?

Respiratory distress syndrome (RDS) is a breathing disorder that affects newborns. RDS rarely
occurs in full-term infants. The disorder is more common in premature infants born about 6
weeks or more before their due dates.
RDS is more common in premature infants because their lungs aren't able to make enough
surfactant (sur-FAK-tant). Surfactant is a liquid that coats the inside of the lungs. It helps keep
them open so that infants can breathe in air once they're born.
Without surfactant, the lungs collapse and the infant has to work hard to breathe. He or she might
not be able to breathe in enough oxygen to support the body's organs. The lack of oxygen may
damage the infant's brain and other organs if proper treatment isn't given.
Most infants who develop RDS show signs of breathing problems and a lack of oxygen at birth
or within the first few hours that follow.

Meconium aspiration syndrome

URL of this page: http://www.nlm.nih.gov/medlineplus/ency/article/001596.htm

Meconium aspiration syndrome is a serious condition in which a newborn breathes a mixture of

meconium and amniotic fluid into the lungs around the time of delivery.

Causes
Meconium is the term used for the early feces (stool) passed by a newborn soon after birth,
before the baby has started to digest breast milk (or formula).
In some cases, the baby passes stools (meconium) while still inside the uterus. This usually
happens when babies are under stress because they are not getting enough blood and oxygen.
Once the meconium has passed into the surrounding amniotic fluid, the baby may breathe
meconium into the lungs. This may happen while the baby is still in the uterus, or still covered
by amniotic fluid after birth. The meconium can also block the infant's airways right after birth.
This condition is called meconium aspiration. It can cause breathing difficulties due to swelling
(inflammation) in the baby's lungs after birth.
Risk factors that may cause stress on the baby before birth include:
• Decreased oxygen to the infant while in the uterus
• Diabetes in the pregnant mother
• Difficult delivery or long labor
• High blood pressure in the pregnant mother
• Passing the due date
Symptoms
• Bluish skin color (cyanosis) in the infant
• Breathing problems
○ Difficulty breathing (the infant needs to work hard to breathe)
○ No breathing
○ Rapid breathing
• Limpness in infant at birth

Exams and Tests

Before birth, the fetal monitor may show a slow heart rate. During delivery or at birth, meconium
can be seen in the amniotic fluid and on the infant.
The infant may need help with breathing or heartbeat immediately after birth, and therefore may
have a low Apgar score.
The health care team will listen to the infant's chest with a stethoscope and may hear abnormal
breath sounds, especially coarse, crackly sounds.
A blood gas analysis will show low blood pH (acidic), decreased oxygen, and increased carbon
dioxide.
A chest x-ray may show patchy or streaky areas in the infant's lungs.

Treatment
The delivering obstetrician or midwife should suction the newborn's mouth as soon as the head
emerges during delivery.
Further treatment is necessary if the baby is not active and crying immediately after delivery. A
tube is placed in the infant's trachea and suction is applied as the endotracheal tube is withdrawn.
This procedure may be repeated until meconium is no longer seen in the suction contents.
The infant may be placed in the special care nursery or newborn intensive care unit for close
observation. Other treatments may include:
• Antibiotics to treat infection
• Breathing machine (ventilator) to keep the lungs inflated
• Oxygen to keep blood levels normal
• Radiant warmer to maintain body temperature
If there have been no signs of fetal distress during pregnancy and the baby is an active full-term
newborn, experts do not recommend deep suctioning of the windpipe, because it carries a risk of
causing a certain type of pneumonia.

Outlook (Prognosis)
Meconium aspiration syndrome is a leading cause of severe illness and death in newborns.
In most cases, the outlook is excellent and there are no long-term health effects.
In more severe cases, breathing problems may occur. They generally go away in 2 - 4 days.
However, rapid breathing may continue for days.
An infant with severe aspiration who needs a breathing machine may have a more guarded
outcome. Lack of oxygen before birth, or from complications of meconium aspiration, may lead
to brain damage. The outcome depends on the degree of brain damage.
Meconium aspiration rarely leads to permanent lung damage.

Possible Complications
• Aspiration pneumonia
• Brain damage due to lack of oxygen
• Breathing difficulty that lasts for several days
• Collapsed lung (pneumothorax)
• Persistent pulmonary hypertension of the newborn (inability to get enough
blood into the lungs to take oxygen to the rest of the body)

Prevention
Risk factors should be identified as early as possible. If the mother's water broke at home, she
should tell the health care provider whether the fluid was clear or stained with a greenish or
brown substance.
Fetal monitoring is started so that any signs of fetal distress can be recognized early. Immediate
intervention in the delivery room can sometimes help prevent this condition. Health care
providers who are trained in newborn resuscitation should be present.

Alternative Names
MAS; Meconium pneumonitis (inflammation of the lungs)
Sudden Infant Death Syndrome (SIDS)
What is Sudden Infant Death Syndrome (SIDS)?
SIDS is the sudden, unexplained death of an infant younger than one year old.
It is the leading cause of death in children between one month and one year of age. Most SIDS
deaths happen when babies are between 2 months and 4 months of age.

How can I reduce the SIDS risk?

Health care providers don’t know what exactly causes SIDS, but they do know certain things can
help reduce the risk of SIDS:
• Always place babies on their backs to sleep – Babies who sleep on their backs are less
likely to die of SIDS than babies who sleep on their stomachs or sides. Placing your baby
on his or her back to sleep is the number one way to reduce the risk of SIDS.
• Use the back sleep position every time – Babies who usually sleep on their backs but
who are then placed on their stomachs, like for a nap, are at very high risk for SIDS. So
it is important for babies to sleep on their backs every time, for naps and at night.
• Place your baby on a firm sleep surface, such as a safety-approved* crib mattress
covered with a fitted sheet - Never place a baby to sleep on a pillow, quilt, sheepskin, or
other soft surface.
 • Keep soft objects, toys, and loose bedding out of your baby’s sleep area – Don’t use
pillows, blankets, quilts, sheepskins, or pillow-like bumpers in your baby’s sleep area.
Keep all items away from the baby’s face.
• Avoid letting your baby overheat during sleep – Dress your baby in light sleep
clothing and keep the room at a temperature that is comfortable for an adult.
• Think about using a clean, dry pacifier when placing your baby down to sleep, but
don’t force the baby to take it. (If you’re breastfeeding, wait until your child is 1 month
old, or is used to breastfeeding before using a pacifier.)
* For more information on crib safety, visit http://www.cpsc.gov.
The NICHD’s publication Safe Sleep for Your Baby: Reduce the Risk of SIDS gives a complete
list of ways to reduce the risk of SIDS.
What does a safe sleep environment look like?
To learn more about safe sleep environment and reducing the risk of SIDS, check out the
NICHD publication Reduce the Risk of SIDS: What does a safe sleep environment look like?
(PDF - 190 KB)

What groups are most at risk for SIDS?

• Babies who are placed to sleep on their stomachs or sides are at higher risk for SIDS than
babies who are placed on their backs to sleep.
• African American babies are more than two times as likely to die of SIDS as white
babies.
• American Indian/Alaska Native babies are nearly three times as likely to die of SIDS as
white babies.
Will my baby develop flat spots on his or her head from back sleeping?
For the most part, flat spots on a baby’s head go away a few months after the baby learns to sit
up. There are other ways to reduce the chance that flat spots will develop on your baby’s head,
such as:
• Providing Tummy Time when your baby is awake and someone is watching. Tummy
Time not only helps prevent flat spots, but it also helps a baby’s head, neck, and shoulder
muscles get stronger.
 • Change the direction that your baby faces in the crib from week to week, so he or she is
not always lying on the same part of the head.
• Avoid too much time in car seats, carriers, and bouncers and hold the baby upright often
during the day.

What Is Hyperbilirubinemia?
By Leigh Walker, eHow Contributor

What Is Hyperbilirubinemia?

Public Domain

Hyperbilirubinemia is the diagnosis given when the body has too much bilirubin in the blood and
other tissues of the body. Bilirubin is formed in the body when red blood cells break down.
Depending on what is causing the hyperbilirubinemia, it may appear at birth or at any time in a
person's life. Yellowing of the skin, or jaundice, is a common sign of hyperbilirubinemia.
 Causes in Infants
1. Newborns can have hyperbilirubinemia simply because their bodies are
unable to excrete the bilirubin fast enough during their first few days of life. A
baby may also get what is called breast milk jaundice. This is when an infant
gets hyperbilirubinemia after its first week of life. This is usually a result of
the infant being dehydrated or having a low calorie intake. Rh disease can
also cause hyperbilirubinemia, as can bleeding and having too many red
blood cells. A baby that has inadequate liver function due to a health
condition or an infection may also develop hyperbilirubinemia. Infants that
are born to diabetic mothers are also more likely to develop the condition.

Causes in Adults
2. While hyperbilirubinemia is more common in babies, adults can develop the
condition for any number of reasons. These include having infections such as
hepatitis A, B, and C, autoimmune disorders, chronically using alcohol, having
liver and pancreas problems/disorders and more.

Diagnosis/Treatment
3. Red blood cell counts can help doctors diagnose hyperbilirubinemia, as well
as blood typing and testing for Rh incompatibility, which is known as the
Coomb's Test. Treatment can include phototherapy which involves exposing
the skin to special blue spectrum lights or placing a fiberoptic blanket
beneath the individual. The lights and blanket may be used separately or in
combination with each other. If the condition is caused by an underlying
condition it will be treated. Infants who have breast milk jaundice will need to
cease from breastfeeding and take formula for approximately two days so the
baby's bilirubin level can lower.

Concerns
4. When large amounts of bilirubin circulate in the body they can go the brain.
This can lead to a condition called kernicterus and it can cause seizures and
brain damage. For this reason, parents should carefully monitor their
newborn's skin, particularly after they take their new baby home, and look for
yellowing. Yellowing of the skin is the common symptom of
hyperbilirubinemia. It generally begins on the face and then moves downward
on the body. Babies may also seem lethargic and have trouble feeding.

Prevention
5. There is no way to completely prevent hyperbilirubinemia. However,
recognizing it and getting treatment as soon as possible can go far in keeping
the condition from becoming dangerous. Women who have their babies at
home should have their baby's checked by a pediatrician the day of birth.

large-for-Gestational-Age (LGA)
Infant

6.
 7.

Infants whose weight is > the 90th percentile for gestational age are classified as
large for gestational age. The predominant cause is maternal diabetes.
Complications include birth trauma, hypoglycemia, and hyperbilirubinemia.
Other than genetically determined size, the major cause of an infant's being large
for gestational age (LGA) is maternal diabetes mellitus. The macrosomia results
from the anabolic effects of high fetal insulin levels produced in response to
excessive blood glucose during gestation. The less well controlled the mother's
diabetes during pregnancy, the more severe is the fetal macrosomia. A rare
nongenetic cause of macrosomia is Beckwith-Wiedemann syndrome
(characterized by macrosomia, omphalocele, macroglossia, and hypoglycemia).
Symptoms, Signs, and Treatment
LGA infants are large, obese, and plethoric. These infants are often listless and
limp and may feed poorly. Delivery complications can occur in any LGA infant.
Metabolic and respiratory complications are specific to LGA infants of diabetic
mothers.
Delivery complications: Because of the infant's large size, vaginal delivery may
be difficult and occasionally results in birth injury. Shoulder dystocia, fractures
of the clavicles or limbs, and perinatal asphyxia may occur. Therefore, cesarean
section should be considered when the fetus is thought to be LGA, especially if
the mother's pelvic measurements are at the lower end of normal.
Infants of diabetic mothers: These infants are very likely to become
hypoglycemic in the first 1 to 2 h after delivery because of the state of
hyperinsulinism and the sudden termination of maternal glucose when the
umbilical cord is cut. Neonatal hypoglycemia can be prevented by close prenatal
control of the mother's diabetes and by the prophylactic IV infusion of 10%
dextrose in water into the infant until early frequent feedings can be established.
Blood glucose levels should be closely monitored by bedside testing during the
transition period.
Hyperbilirubinemia (see also Metabolic, Electrolyte, and Toxic Disorders in
Neonates: Neonatal Hyperbilirubinemia) is common because of intolerance for
oral feedings in the earliest days of life, which increases the enterohepatic
circulation of bilirubin. Hyperbilirubinemia can also result from the infant's high
Hct (another accompanying problem in infants of diabetic mothers).
Because surfactant production (and hence pulmonary maturation) may be
delayed until late in gestation, respiratory distress syndrome may develop even if
the infant is delivered only a few weeks prematurely. The lecithin/sphingomyelin
ratio, and especially the presence of phosphatidyl glycerol, in amniotic fluid
obtained by amniocentesis can evaluate fetal lung maturity and help determine
the optimal time for safe delivery. Lung maturity can be assumed only if
phosphatidyl glycerol is present. Treatment is discussed elsewhere (see
Respiratory Disorders in Neonates, Infants, and Young Children: Treatment).
Ssss

Infants whose weight is < the 10th percentile for gestational age are classified as small for
gestational age. Complications include perinatal asphyxia, meconium aspiration, and
hypoglycemia.
Etiology
An infant may be small at birth because of genetic factors. Nongenetic factors that can restrict
intrauterine growth usually are not apparent before 32 to 34 wk gestation; these include placental
insufficiency from maternal disease involving the small blood vessels (as in preeclampsia,
primary hypertension, renal disease, or long-standing diabetes); placental involution
accompanying postmaturity; and infectious agents such as cytomegalovirus, rubella virus, or
Toxoplasma gondii. An infant may also be small for gestational age (SGA) if the mother is an
opioid or cocaine addict or a heavy user of alcohol or, to a lesser degree, if she smoked cigarettes
during pregnancy.
Symptoms and Signs
Despite their size, SGA infants have physical characteristics (eg, skin appearance, ear cartilage,
sole creases) and behavior (eg, alertness, spontaneous activity, zest for feeding) similar to those
of normal-sized infants of like gestational age.
If growth restriction is caused by placental insufficiency and, therefore, malnutrition, the infant's
weight is most affected, with a relative sparing of growth of the brain, cranium, and long bones
(asymmetric growth restriction). In contrast, many genetic disorders and congenital infections
cause symmetric growth restriction, in which height, weight, and head circumference are about
equally affected.
Complications: Full-term SGA infants do not have the complications related to organ system
immaturity that premature infants of similar size have. They are, however, at risk of perinatal
asphyxia, meconium aspiration, and hypoglycemia.
Perinatal asphyxia is the most serious potential complication. It is a risk during labor if
intrauterine growth restriction is caused by placental insufficiency (with marginally adequate
placental perfusion), because each uterine contraction slows or stops maternal placental
perfusion by compressing the spiral arteries. Therefore, when placental insufficiency is
suspected, the fetus should be assessed before labor and the fetal heart rate monitored during
labor. If fetal compromise is detected, rapid delivery, often by cesarean section, is indicated.
Meconium aspiration may occur during perinatal asphyxia. SGA infants, especially those who
are postmature, may pass meconium into the amniotic sac and begin deep gasping movements.
The consequent aspiration is likely to result in meconium aspiration syndrome (often most severe
in growth-restricted or postmature infants, because the meconium is contained in a smaller
volume of amniotic fluid—see Respiratory Disorders in Neonates, Infants, and Young Children:
Meconium Aspiration Syndrome).
Hypoglycemia often occurs in the early hours and days of life due to a lack of adequate
glycogen stores (see Metabolic, Electrolyte, and Toxic Disorders in Neonates: Neonatal
Hypoglycemia).
Polycythemia may occur when SGA fetuses experience chronic mild hypoxia caused by
placental insufficiency. Erythropoietin release is increased, leading to an increased rate of
erythrocyte production. The neonate with polycythemia at birth appears ruddy and may be
tachypneic or lethargic.
Prognosis and Treatment
If asphyxia can be avoided, neurologic prognosis is quite good.
Infants who are SGA because of genetic factors, congenital infection, or maternal drug use often
have a worse prognosis, depending on the specific diagnosis. If intrauterine growth restriction is
caused by chronic placental insufficiency, adequate nutrition may allow SGA infants to
demonstrate remarkable “catch-up” growth after delivery.
Underlying conditions and complications are treated. There is no specific intervention for the
SGA state, but prevention is aided by prenatal advice on the importance of avoiding alcohol,
tobacco, and illicit drugs.

Small for Gestational Age

What is small for gestational age (SGA)?

Small for gestational age (SGA) is a term used to describe a baby who is smaller than the usual
amount for the number of weeks of pregnancy. SGA babies usually have birthweights below the
10th percentile for babies of the same gestational age. This means that they are smaller than 90
percent of all other babies of the same gestational age.
SGA babies may appear physically and neurologically mature but are smaller than other babies
of the same gestational age. SGA babies may proportionately small (equally small all over) or
they may be of normal length and size but have lower weight and body mass. SGA babies may
be premature (born before 37 weeks of pregnancy), full term (37 to 41 weeks), or postterm (after
42 weeks of pregnancy).
What causes small for gestational age (SGA)?
Although some babies are small because of genetics (their parents are small), most SGA babies
are small because of fetal growth problems that occur during pregnancy. Many babies with SGA
have a condition called intrauterine growth restriction (IUGR). IUGR occurs when the fetus does
not receive the necessary nutrients and oxygen needed for proper growth and development of
organs and tissues. IUGR can begin at any time in pregnancy. Early-onset IUGR is often due to
chromosomal abnormalities, maternal disease, or severe problems with the placenta. Late-onset
growth restriction (after 32 weeks) is usually related to other problems.
Some factors that may contribute to SGA and/or IUGR include the following:
• Maternal factors:
○ high blood pressure
○ chronic kidney disease
○ advanced diabetes
○ heart or respiratory disease
○ malnutrition, anemia
○ infection
○ substance use (alcohol, drugs)
○ cigarette smoking
 • Factors involving the uterus and placenta:
○ decreased blood flow in the uterus and placenta
○ placental abruption (placenta detaches from the uterus)
○ placenta previa (placenta attaches low in the uterus)
○ infection in the tissues around the fetus
• Factors related to the developing baby (fetus):
○ multiple gestation (twins, triplets, etc.)
○ infection
○ birth defects
○ chromosomal abnormality
Why is small for gestational age (SGA) a concern?
When the fetus does not receive enough oxygen or nutrients during pregnancy, overall body and
organs growth is limited, and tissue and organ cells may not grow as large or as numerous. Some
of the conditions that cause SGA and IUGR restrict blood flow through the placenta. This can
cause the fetus to receive less oxygen than normal, increasing the risks for the baby during
pregnancy, delivery, and afterwards.
Babies with SGA and/or IUGR may have problems at birth including the following:
 • decreased oxygen levels
• low Apgar scores (an assessment that helps identify babies with difficulty adapting after
delivery)
• meconium aspiration (inhalation of the first stools passed in utero) which can lead to
difficulty breathing
• hypoglycemia (low blood sugar)
• difficulty maintaining normal body temperature
• polycythemia (too many red blood cells)
How is small for gestational age (SGA) diagnosed?
The baby with SGA is often identified before birth. During pregnancy, a baby's size can be
estimated in different ways. The height of the fundus (the top of a mother's uterus) can be
measured from the pubic bone. This measurement in centimeters usually corresponds with the
number of weeks of pregnancy after the 20th week. If the measurement is low for the number of
weeks, the baby may be smaller than expected.
Although many SGA babies have low birthweight, they are not all premature and may not
experience the problems of premature babies. Other SGA babies, especially those with IUGR,
appear thin, pale, and with loose, dry skin. The umbilical cord is often thin, and dull-looking
rather than shiny and fat. They sometimes have a wide-eyed look.
Other diagnostic procedures may include the following:
• ultrasound - Ultrasound (a test using sound waves to create a picture of internal
structures) is a more accurate method of estimating fetal size. Measurements can be taken
of the fetus' head and abdomen and compared with a growth chart to estimate fetal
weight. The fetal abdominal circumference is a helpful indicator of fetal nutrition.
• Doppler flow - Another way to interpret and diagnose IUGR during pregnancy is
Doppler flow, which use sound waves to measure blood flow. The sound of moving
blood produces wave-forms that reflect the speed and amount of the blood as it moves
through a blood vessel. Blood vessels in the fetal brain and the umbilical cord blood flow
can be checked with Doppler flow studies.
• mother's weight gain - A mother's weight gain can also indicate a baby's size. Small
maternal weight gains in pregnancy may correspond with a small baby
• gestational assessment - Babies are weighed within the first few hours after birth. The
 weight is compared with the baby's gestational age and recorded in the medical record.
The birthweight must be compared to the gestational age. Some physicians use a formula
for calculating a baby's body mass to diagnose SGA.
Treatment of babies who are small for gestational age (SGA)

Specific treatment for SGA will be determined by your baby's physician based on:
 • your baby's gestational age, overall health, and medical history
• extent of the condition
• your baby's tolerance for specific medications, procedures, or therapies
• expectations for the course of the condition
• your opinion or preference
Babies with SGA may be physically more mature than their small size indicates. But they may
be weak and less able to tolerate large feedings or to stay warm.
Treatment of the SGA baby may include:
 • temperature controlled beds or incubators
• tube feedings (if the baby does not have a strong suck)
• checking for hypoglycemia (low blood sugar) through blood tests
• monitoring of oxygen levels
Babies who are SGA and are also premature may have additional needs including oxygen and
mechanical help to breathe.
Prevention of small for gestational age (SGA)
Prenatal care is important in all pregnancies, and especially to identify problems with fetal
growth. Stopping smoking and use of substances such as drugs and alcohol are essential to a
healthy pregnancy. Eating a healthy diet in pregnancy may also help.