, Volume 191, Issue 4, pp 425–433 | Cite as

Characteristics of Respiratory Distress Syndrome in Infants of Different Gestational Ages

  • Huiqing Sun
  • Falin Xu
  • Hong Xiong
  • Wenqing Kang
  • Qiongdan Bai
  • Yinghui Zhang
  • Chongchen Zhou
  • Fangli Zhuang
  • Xiaoyang Wang
  • Changlian Zhu



The purpose of this study was to compare the risk factors, clinical characteristics, and complications of respiratory distress syndrome (RDS) in infants delivered very preterm, late preterm, and term in order to help optimize the management of RDS in neonates.


A retrospective study was conducted on neonates admitted to the NICU between January 2006 and December 2010. The enrolled infants with RDS were categorized as very preterm (<320/7 weeks gestation), moderately preterm (320/7–336/7 weeks), late preterm (340/7–366/7 weeks), and term (370/7–420/7 weeks). The rates, potential risk factors, clinical characteristics, and complications of RDS of these four groups were comparatively analyzed.


There was an increasing trend in incidence of RDS among the NICU admissions annually. Caesarean section without labor was significantly associated with RDS in term and late preterm infants (P < 0.001). Rates of requirements for ventilator and pulmonary surfactant were similar in very preterm and term infants but significantly lower in late preterm infants (P < 0.001). The oxygenation index value was not substantially lower in late preterm and term infants compared to very preterm infants, and the arterial oxygenation efficiency was improved slowly (P < 0.001). Incidence of pneumonia and occurrence of pneumothorax were significantly higher in term infants (P < 0.001).


Term infants with RDS showed an association of RDS with caesarean section without labor and lung infection. These infants also showed slower improvement of oxygenation after surfactant administration and mechanical ventilation, and they experienced a high rate of pneumothorax complication, which was also noticed in late preterm neonates.


Respiratory distress syndrome Preterm infants Term infants Caesarean section Lung infection 



Bronchopulmonary dysplasia


Conventional mechanical ventilation


Continuous positive airway pressure


C-reactive protein


Fraction of inspiration oxygen




Intraventricular hemorrhage


Mean airway pressure


Multiple organ system failure


Necrotizing enterocolitis


Neonatal intensive care unit


Oxygenation index


Partial arterial oxygen pressure


Pulmonary surfactant


Respiratory distress syndrome


  1. 1.
    Hankins GD, Longo M (2006) The role of stillbirth prevention and late preterm (near-term) births. Semin Perinatol 30(1):20–23PubMedCrossRefGoogle Scholar
  2. 2.
    Masoura S, Kalogiannidis I, Margioula-Siarkou C, Diamanti E, Papouli M, Drossou-Agakidou V, Prapas N, Agorastos T (2012) Neonatal outcomes of late preterm deliveries with pre-eclampsia. Minerva Ginecol 64(2):109–115PubMedGoogle Scholar
  3. 3.
    Moutquin JM (2003) Classification and heterogeneity of preterm birth. BJOG 110(Suppl 20):30–33PubMedGoogle Scholar
  4. 4.
    Linhart Y, Bashiri A, Maymon E, Shoham-Vardi I, Furman B, Vardi H, Mazor M (2000) Congenital anomalies are an independent risk factor for neonatal morbidity and perinatal mortality in preterm birth. Eur J Obstet Gynecol Reprod Biol 90(1):43–49PubMedCrossRefGoogle Scholar
  5. 5.
    Bérard A, Le Tiec M, De Vera MA (2012) Study of the costs and morbidities of late-preterm birth. Arch Dis Child Fetal Neonatal Ed 97(5):F329–F334PubMedCrossRefGoogle Scholar
  6. 6.
    Wang ML, Dorer DJ, Fleming MP, Catlin EA (2004) Clinical outcomes of near-term infants. Pediatrics 114(2):372–376PubMedCrossRefGoogle Scholar
  7. 7.
    Hermansen CL, Lorah KN (2007) Respiratory distress in the newborn. Am Fam Physician 76(7):987–994PubMedGoogle Scholar
  8. 8.
    Schlapbach LJ, Frey S, Bigler S, Manh-Nhi C, Aebi C, Nelle M, Nuoffer JM (2011) Copeptin concentration in cord blood in infants with early-onset sepsis, chorioamnionitis and perinatal asphyxia. BMC Pediatr 11:38PubMedCrossRefGoogle Scholar
  9. 9.
    Wylie BJ, Gilbert S, Landon MB, Spong CY, Rouse DJ, Leveno KJ, Varner MW, Caritis SN, Meis PJ, Wapner RJ et al (2010) Comparison of transverse and vertical skin incision for emergency cesarean delivery. Obstet Gynecol 115(6):1134–1140PubMedCrossRefGoogle Scholar
  10. 10.
    Walsh MC, Szefler S, Davis J, Allen M, Van Marter L, Abman S, Blackmon L, Jobe A (2006) Summary proceedings from the bronchopulmonary dysplasia group. Pediatrics 117(3 Pt 2):S52–S56PubMedGoogle Scholar
  11. 11.
    Kim GB (2010) Pulmonary hypertension in infants with bronchopulmonary dysplasia. Korean J Pediatr 53(6):688–693PubMedCrossRefGoogle Scholar
  12. 12.
    Berman L, Moss RL (2011) Necrotizing enterocolitis: an update. Semin Fetal Neonatal Med 16(3):145–150PubMedCrossRefGoogle Scholar
  13. 13.
    Duke T (2005) Neonatal pneumonia in developing countries. Arch Dis Child Fetal Neonatal Ed 90(3):F211–F219PubMedCrossRefGoogle Scholar
  14. 14.
    Raju TN, Higgins RD, Stark AR, Leveno KJ (2006) Optimizing care and outcome for late-preterm (near-term) infants: a summary of the workshop sponsored by the National Institute of Child Health and Human Development. Pediatrics 118(3):1207–1214PubMedCrossRefGoogle Scholar
  15. 15.
    Roberge S, Lacasse Y, Tapp S, Tremblay Y, Kari A, Liu J, Fekih M, Qublan HS, Amorim MM, Bujold E (2011) Role of fetal sex in the outcome of antenatal glucocorticoid treatment to prevent respiratory distress syndrome: systematic review and meta-analysis. J Obstet Gynaecol Can 33(3):216–226PubMedGoogle Scholar
  16. 16.
    Schempf AH, Branum AM, Lukacs SL, Schoendorf KC (2007) Maternal age and parity-associated risks of preterm birth: differences by race/ethnicity. Paediatr Perinat Epidemiol 21(1):34–43PubMedCrossRefGoogle Scholar
  17. 17.
    Obiechina N, Okolie V, Eleje G, Okechukwu Z, Anemeje O (2011) Twin versus singleton pregnancies: the incidence, pregnancy complications, and obstetric outcomes in a Nigerian tertiary hospital. Int J Womens Health 3:227–230PubMedGoogle Scholar
  18. 18.
    Yuan W, Duffner AM, Chen L, Hunt LP, Sellers SM, Bernal AL (2010) Analysis of preterm deliveries below 35 weeks’ gestation in a tertiary referral hospital in the UK. A case-control survey. BMC Res Notes 3:119PubMedCrossRefGoogle Scholar
  19. 19.
    Hansen AK, Wisborg K, Uldbjerg N, Henriksen TB (2008) Risk of respiratory morbidity in term infants delivered by elective caesarean section: cohort study. BMJ 336(7635):85–87PubMedCrossRefGoogle Scholar
  20. 20.
    Wu XJ, Zhang XD, Shi LP (2009) Retrospective analysis of elective caesarean section and respiratory distress syndrome in the term neonates. Zhonghua Er Ke Za Zhi 47(9):658–661PubMedGoogle Scholar
  21. 21.
    Ramachandrappa A, Jain L (2008) Elective cesarean section: its impact on neonatal respiratory outcome. Clin Perinatol 35(2):373-393, viiGoogle Scholar
  22. 22.
    Yurdakok M, Ozek E (2012) Transient tachypnea of the newborn: the treatment strategies. Curr Pharm Des 18(21):3046–3049PubMedCrossRefGoogle Scholar
  23. 23.
    Roth-Kleiner M, Wagner BP, Bachmann D, Pfenninger J (2003) Respiratory distress syndrome in near-term babies after caesarean section. Swiss Med Wkly 133(19–20):283–288PubMedGoogle Scholar
  24. 24.
    Gouyon JB, Ribakovsky C, Ferdynus C, Quantin C, Sagot P, Gouyon B (2008) Severe respiratory disorders in term neonates. Paediatr Perinat Epidemiol 22(1):22–30PubMedGoogle Scholar
  25. 25.
    Speer CP (2011) Neonatal respiratory distress syndrome: an inflammatory disease? Neonatology 99(4):316–319PubMedCrossRefGoogle Scholar
  26. 26.
    Liu J, Shi Y, Dong JY, Zheng T, Li JY, Lu LL, Liu JJ, Liang J, Zhang H, Feng ZC (2010) Clinical characteristics, diagnosis and management of respiratory distress syndrome in full-term neonates. Chin Med J (Engl) 123(19):2640–2644Google Scholar
  27. 27.
    Cheong N, Madesh M, Gonzales LW, Zhao M, Yu K, Ballard PL, Shuman H (2006) Functional and trafficking defects in ATP binding cassette A3 mutants associated with respiratory distress syndrome. J Biol Chem 281(14):9791–9800PubMedCrossRefGoogle Scholar
  28. 28.
    Pfister RH, Soll RF (2012) Initial respiratory support of preterm infants: the role of CPAP, the INSURE method, and noninvasive ventilation. Clin Perinatol 39(3):459–481PubMedCrossRefGoogle Scholar
  29. 29.
    Gizzi C, Papoff P, Giordano I, Massenzi L, Barbara CS, Campelli M, Panetta V, Agostino R, Moretti C (2012) Flow-synchronized nasal intermittent positive pressure ventilation for infants < 32 weeks’ gestation with respiratory distress syndrome. Crit Care Res Pract 2012:301818PubMedGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2013

Authors and Affiliations

  • Huiqing Sun
    • 1
    • 2
  • Falin Xu
    • 1
  • Hong Xiong
    • 2
  • Wenqing Kang
    • 2
  • Qiongdan Bai
    • 1
  • Yinghui Zhang
    • 2
  • Chongchen Zhou
    • 2
  • Fangli Zhuang
    • 1
  • Xiaoyang Wang
    • 1
    • 3
    • 4
  • Changlian Zhu
    • 1
    • 3
    • 5
  1. 1.Department of PediatricsThe Third Affiliated Hospital of Zhengzhou UniversityZhengzhouChina
  2. 2.Department of PediatricsZhengzhou Children’s HospitalZhengzhouChina
  3. 3.Henan Key Laboratory for Neonatal Brain InjuryZhengzhouChina
  4. 4.Perinatal Center, Sahlgrenska AcademyUniversity of GothenburgGöteborgSweden
  5. 5.Center for Brain Repair and Rehabilitation, Institute of Neuroscience and PhysiologyUniversity of GothenburgGöteborgSweden

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