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Pathophysiology, clinical manifestations, and diagnosis of respiratory distress syndrome in the newborn

Richard Martin, MD
Section Editor
Joseph A Garcia-Prats, MD
Deputy Editor
Melanie S Kim, MD


Respiratory distress syndrome (RDS), formerly known as hyaline membrane disease, is a common problem in preterm infants. This disorder is caused primarily by deficiency of pulmonary surfactant in an immature lung. RDS is a major cause of morbidity and mortality in preterm infants.

The pathophysiology and clinical features of RDS will be presented here. The management of RDS and other disorders of perinatal transition are discussed separately. (See "Prevention and treatment of respiratory distress syndrome in preterm infants" and "Clinical features and diagnosis of meconium aspiration syndrome" and "Persistent pulmonary hypertension of the newborn" and "Transient tachypnea of the newborn".)


Knowledge of the normal fetal lung development is central to understanding the pathophysiology of neonatal RDS, which is due to inadequate surfactant activity resulting from lung immaturity.

Normal fetal alveolar development occurs in the following stages [1]:

Embryonic period – At approximately 26 days gestation, the embryonic stage begins with the first appearance of the fetal lung, which appears as a protrusion of the foregut. The initial branching of the lung occurs at 33 days gestation forming the prospective main bronchi, which begin to extend into the mesenchyme. Further branching forms the segmental bronchi as the lung enters the next stage of development.

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Literature review current through: Dec 2017. | This topic last updated: Aug 23, 2016.
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