The Global Health Burden of Neonatal Respiratory Distress Syndrome (RDS)
Preterm birth is a leading cause of death globally in neonates and children under age 5, and respiratory distress syndrome (RDS) is a leading cause of death in preterm infants. RDS in preterm infants is due to their immature lungs and begins immediately after birth. It results in nearly 100% mortality if left untreated.
Proven preventions and treatments for RDS exist. They are not routinely administered in low- and middle-income countries (LMICs), however, because of constraints there. New solutions in LMICs are needed during antenatal care at the primary health care (PHC) level and at Neonatal Intensive Care Units (NICUs) at higher levels of the health system.
Etiology
Most RDS is Caused by Preterm Birth
RDS is due to a deficiency in lung surfactant, a lubricant lining the lungs and alveoli that is required to keep the alveoli from collapsing. This deficiency in the lungs of babies born preterm is caused by either inadequate production or inactivation of surfactant.
The incidence of RDS increases with decreasing gestational age at birth. Nearly 100% of babies born at 24 weeks have RDS, as compared to around 5% of babies born at 34 weeks and less than 1% of babies born at 37 weeks. However, while late preterm births have the lowest relative risk of RDS, they account for the largest absolute number of cases.
Neonatal Respiratory Distress Syndrome - StatPearls - NCBI Bookshelf (nih.gov)
Disease Burden
RDS is a Leading Cause of Death in Preterm Infants
For preterm infants, for whom RDS is a leading cause of death, there are stark disparities in survival rates: half of the babies born at 32 weeks or earlier (2 months early) in low-income settings die, while in high-income countries nearly all these babies survive.
Most infant deaths from RDS are in Sub-Saharan Africa and South Asia. Gates Foundation modeling of data from these regions predicts approximately 4.9 million RDS cases and 600,000 deaths in 2025. Given the predicted lack of change in trends, this could yield a total of 72 million cases and 7.5 million deaths from 2025-2040 in Sub-Saharan Africa and South Asia.
RDS is Preventable and Treatable with Proven Interventions
High-quality antenatal care, including access to fetal ultrasound, can help prevent preterm birth and therefore RDS as well. For mothers identified as at risk of preterm delivery, this care can also ensure safe and effective use of antenatal corticosteroids to prevent or ameliorate RDS. Upon birth, babies with RDS need to be immediately diagnosed, stabilized, and referred to a Neonatal Intensive Care Unit (NICU), where their breathing can be supported with a neonatal Continuous Positive Airway Pressure (CPAP) device. CPAP is the single most critical element for addressing the RDS burden. In LMICs, however, all these technologies and treatments either have limited availability or there is limited access to them. This highlights opportunities for technology innovation to address the burden of RDS in each country’s context.
Patient Experience
Specialized Care is Required to Prevent and Treat RDS
Learn more about the patient experience across RDS care
Technology Solutions
New Tools and Equipment are Needed for RDS Care
Learn more about how GH Labs and others are addressing key technical gaps in RDS care