Risk Factors for Respiratory Distress Syndrome (RDS) in Newborns
The major risk factor for RDS is prematurity, as immature lungs lack adequate surfactant. Other significant contributors include maternal diabetes, particularly if poorly controlled, which delays surfactant synthesis, and cesarean section without labor, especially elective procedures, since labor enhances surfactant release. Asphyxia or perinatal hypoxia can also impair surfactant production. Additional risks are multiple gestation (due to prematurity), male sex, previous sibling with RDS suggesting genetic predisposition, and White race, which shows a slightly higher incidence.

Differential Diagnosis
RDS must be distinguished from other neonatal respiratory disorders: Transient Tachypnea of the Newborn (TTN) from delayed lung fluid clearance; neonatal pneumonia (often linked with sepsis); meconium aspiration syndrome (MAS) in term/post-term infants; persistent pulmonary hypertension (PPHN); congenital heart disease; air leak syndromes such as pneumothorax; and systemic issues like hypoglycemia, hypothermia, or anemia.

Management
Treatment aims to correct surfactant deficiency and provide supportive care. Antenatal corticosteroids (betamethasone) given to mothers at risk of preterm delivery significantly reduce RDS severity. In the delivery room, prompt resuscitation and stabilization are crucial, favoring gentle ventilation. Exogenous surfactant therapy via endotracheal tube is highly effective, ideally administered early. Respiratory support typically begins with continuous positive airway pressure (CPAP), while mechanical ventilation is reserved for severe cases, using lung-protective strategies. Supportive measures include careful fluid restriction, nutritional support, thermal regulation, and continuous monitoring of vitals and gases. Empiric antibiotics are often started until infection is excluded. Ongoing care addresses complications such as patent ductus arteriosus (PDA), bronchopulmonary dysplasia, or intraventricular hemorrhage.