Hyaline membrane disease


Neonatal respiratory distress syndrome (NRDS) happens when a newborn baby's lungs aren't fully developed and they 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, acute respiratory distress syndrome (ARDS) isn't related. ARDS is caused by a serious underlying health condition and can affect people of any age.

Why it happens

NRDS most often occurs when there isn't enough surfactant in the lungs. This substance, made up of proteins and fats, helps keep the lungs inflated and prevents parts of the lung called air sacs collapsing.

A baby normally begins producing surfactant sometime between weeks 24 and 28 of pregnancy. Most babies produce enough surfactant to breathe normally by week 34.

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

Occasionally, NRDS occurs in babies that aren't born prematurely. This is usually caused by other risk factors, such as:

  • the mother having diabetes
  • the baby being underweight
  • poor lung development, which can be caused by a variety of illnesses

Problems with the genes can play a role in lung development, but this is very rare.

It's estimated half of all babies born before 28 weeks of pregnancy will develop NRDS. However, this has reduced in recent years, as steroid injections can be given to mothers at risk of NRDS during premature labour.

Signs and symptoms

The signs 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

As premature babies are usually born in hospital, most babies with NRDS are already in hospital when they develop these problems and receive treatment.

If you give birth outside hospital and notice the above symptoms in your child, 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 being absorbed in the blood, using a sensor attached to the fingertip, ear or toe
  • a chest X-ray – to look for the distinctive cloudy appearance of NRDS

Treating NRDS

Most babies with NRDS need breathing help with extra oxygen and possibly some form of ventilator support.

Babies needing ventilation can often be treated with a medication directly into the lungs called artificial surfactant, which helps restore normal lung function.

Some cases can be prevented or at least made less severe by treating the mother with a medication called betamethasone before birth.

Read more about treating NRDS.


In the majority of cases NRDS can be treated successfully, and deaths directly linked to NRDS are rare in the UK.

However, in more severe cases there's a risk of further problems. These can include scarring to the lungs, leading to longer-term breathing problems. There's also a risk of brain damage, which may result in problems such as learning difficulties.

Read more about the possible complications of NRDS.