What are the key clinical signs and symptoms of Respiratory Distress Syndrome (RDS) in premature infants that I should look for during assessment?

When assessing premature infants for respiratory distress syndrome, key clinical signs and symptoms that should be evaluated include:

• Respiratory Effort and Pattern: Look for grunting ²,³, marked chest recession or moderate/severe chest indrawing ²,³, and the use of accessory muscles of respiration while the baby is at rest ². Observe for nasal flaring ²,³. Assess the respiratory rate; a rate over 60 breaths/minute indicates tachypnoea ²,³, and over 70 breaths/minute suggests severe respiratory distress ². Apnoea, whether observed or reported, is a critical sign ². Be aware that listlessness or decreased respiratory effort may indicate impending respiratory failure ², as can poor respiratory effort or a silent chest ².
• Oxygenation and Circulation: Check for cyanosis, which can appear as bluish lips or extremities ², or pale, mottled, ashen, or blue skin, lips, or tongue ²,³. Central cyanosis is a sign of severe distress ². Measure oxygen saturation using pulse oximetry; a persistent saturation of less than 92% when breathing air ² or ≤ 95% in air ³ is concerning. Continuous pulse oximetry should be used to measure oxygen saturation in preterm babies ¹. Record the baby's pulse, noting any tachycardia (e.g., over 160 beats/minute in an infant under 12 months) ²,³, and blood pressure ². Assess capillary refill time; a time of three seconds or more indicates poor circulation ²,³.
• General Condition and Hydration: Note the baby's agitation and consciousness, as agitation and behavioural changes can be a sign of hypoxia ². Look for signs of exhaustion ². Observe for altered consciousness, such as not waking, not staying awake if roused, or not responding to normal social cues ²,³. Assess feeding difficulties, such as difficulty with breastfeeding or inadequate oral fluid intake (50–75% of usual volume) ², or poor feeding in infants ³. Evaluate for clinical dehydration, indicated by reduced skin turgor, dry mucous membranes, and/or reduced urine output ²,³. Record the baby's temperature, especially noting a temperature of 38°C or higher in an infant aged three months or less ².