Respiratory Distress Syndrome (RDS)

Respiratory Distress Syndrome (RDS) is a birth complication that involves a serious breathing problem that may occur in premature babies whose lungs are not fully developed. Babies born before 28 weeks of gestation are at a particularly high risk of RDS, but the condition may also affect full-term babies. An estimated seven percent of all newborns will suffer from respiratory distress syndrome birth complication.

Medical interventions, such as oxygenation and ventilation are usually required. When the risk of premature birth is high, the medical providers should consider corticosteroids administration as a preventative measure to the expectant mother between 24 and 34 weeks of gestation. The medical team should also be prepared to provide timely neonatal resuscitation according to the updated guidelines to babies born with RDS.

Failure to recognize the risk factors for RDS or respond to RDS after birth with appropriate neonatal resuscitation can lead to a birth injury including a brain injury like hypoxic ischemic encephalopathy (HIE) which is a leading cause of cerebral palsy.

Respiratory distress syndrome in babies primarily occurs due to the deficiency of surfactant in the lungs. Surfactant is a slippery liquid present in fully developed lungs, which increases the airflow in lungs and prevents the air sacs from collapsing with deflation. Surfactant is produced in the baby’s lungs at about 26 weeks of gestation. As the fetal growth progresses, the lungs produce higher volumes of surfactant.

The small air sacs in the baby’s lungs are coated with surfactant to prevent them from collapsing. As the air sacs open, the oxygen enters the bloodstream from the lungs, while carbon dioxide from the bloodstream goes into the lungs. In preterm babies, the lack of surfactant can cause the air sacs to deflate, leading to respiratory distress syndrome.

The doctors like obstetricians and labor and delivery/neonatal nurses should recognize the risk factors of RDS so that they can diagnose and treat the condition early. Risk factors include:

• Induction of labor or cesarean section before the baby is full-term
• Birth complications that reduce the blood flow to the baby
• Rapid labor
• Baby is sick at the time of birth
• Hypothermia (baby is unable to keep body temperature warm at the time birth)
• Maternal diabetes
• Maternal infection
• Twins or multiple pregnancy
• A sibling was born with a RDS birth complication

Babies with respiratory distress syndrome may show the following signs and symptoms:

• Rapid breathing (tachypnea) right after birth
• Grunting sound accompanies each breath
• Flaring (widening) nostrils with each breath
• Bluish tone or changing color of the baby’s lips, toes, and fingers
• Chest retractions (inward pull of the muscles between the ribs and breastbone when breathing)

Recognizing these signs and symptoms of RDS by the neonatal medical team is critical to initiating quick treatment in order to prevent RDS from leading to a hypoxic or anoxic brain injury to the baby.

Babies with respiratory distress syndrome will usually exhibit signs of tachypnea (fast breathing) with a respiratory rate exceeding 60 respirations per minute. Nasal flaring, chest retractions, and grunting are other common signs. The initial evaluation should include a thorough physical examination and medical history.

The medical team should monitor the baby’s vital signs, use a pulse oximeter to determine oxygen saturation, and perform blood gas testing. Medical tests may include:

• Chest radiography to determine the functioning of the lungs and heart
• Blood, tracheal aspirate, and cerebrospinal fluid cultures
• Blood tests to rule out an infection
• Blood gas tests to determine if the baby has sufficient oxygen in the blood
• Echocardiogram and other heart tests to identify potential congenital heart defects

Babies with respiratory distress syndrome may be treated with neonatal resuscitation using non-invasive techniques and respiratory support. The medical team can provide oxygen via nasal CPAP (continuous positive airway pressure), nasal cannula, bag/mask, or oxygen hood. In more severe cases, intubation and ventilator support is usually required.

Surfactant therapy through intubation followed by nasal CPAP is now increasingly used. The baby should be screened for congenital heart defects after 24 hours. It is equally important to focus on any other possible causes of RDS in premature babies, such as infection.

It is critical that these neonatal resuscitation interventions take place quickly to avoid a hypoxic or anoxic brain injury. Failure to quickly initiate such treatment is often considered medical malpractice if the delay results in an unnecessary birth injury such as HIE or cerebral palsy.

Delayed diagnosis or improper treatment for neonatal RDS may lead to a number of life-threatening complications, such as:

• Intraventricular hemorrhage or IVH (brain bleeds in the ventricles)
• Intracranial hemorrhage (bleeds between the brain tissue and skull)
• Periventricular leuckomalacia (cerebral white matter injury)
• Hypoxic Ischemic Encephalopathy (HIE)
• Bronchopulmonary dysplasia or BPD (chronic lung disease)
• Pneumothorax (air leaks into the chest cavity from the lungs)
• Atelectasis (lung collapse)
• Sepsis (blood infection)
• Vision impairment
• Intellectual disability
• Cerebral palsy

Prevention of neonatal respiratory distress syndrome largely boils down to prevention of preterm birth and administration of proper treatment when preterm birth is unavoidable. Proper monitoring and care during pregnancy is vital so that the risk of premature birth is identified, and appropriate medical interventions are made.

When premature birth is imminent via labor induction or cesarean section, medical providers should perform 3D ultrasound exams and other lab tests to assess fetal lung maturity. After carefully weighing the risks of delaying preterm birth versus the risk of RDS, the medical team can make the best decision.

When preterm delivery between 24 and 34 weeks of gestation is necessary, the medical providers should consider administering corticosteroid therapy to promote the baby’s lung development and sufficient production of surfactant. Two doses of betamethasone 12 mg or four doses of dexamethasone 6 mg may be delivered to the mother at least 48 hours prior to delivery in order to induce surfactant production in the baby’s lungs.

In absence of corticosteroid therapy during pregnancy, prophylactic surfactant therapy may be administered to the premature baby who is at a high risk of developing respiratory distress syndrome. Studies have shown that surfactant therapy given through the trachea (intratracheal) may reduce the risk of severe lung complications and neonatal death.

Parents whose children suffer from respiratory distress syndrome related birth injuries or birth complications want and deserve answers as to the cause of their child’s injury and whether mistakes by the doctors and nurses contributed to the injury.

• Were there signs of birth injuries or birth complications during the pregnancy, labor, and delivery process, or presence of risk factors, which were either not recognized or properly treated?
• Did your baby require corticosteroids prior to birth, but the treatment was not given or improperly given.
• During the labor and delivery, were there clear indications that their baby was suffering from fetal distress, but appropriate actions were not taken by the obstetrician or nurses?
• Did the medical team fail to order a series of tests to diagnose the condition in a timely manner?
• Was the decision to perform a cesarean delivery delayed?
• Did the neonatal resuscitation team delay in providing important breathing support?
• Should brain cooling (also called “hypothermia therapy”) have been offered to your baby, but the doctors and nurses failed to perform the appropriate tests or ignored the results of the tests?

Our national birth injury attorneys that have seen the unfortunate birth complications due to the failure to diagnose and treat RDS have extensive experience in this and all areas of birth injury medical malpractice. The lawyers and nurses at Miller Weisbrod Olesky will help you determine if mistakes of the medical providers caused a birth injury to your child, including Hypoxic-Ischemic Encephalopathy (HIE) or cerebral palsy.

Our award-winning birth injury attorneys have represented families all over the United States in their time of need after a birth injury. We use our experience and expertise to obtain for you and your child a medical malpractice settlement that will help provide specialized medical therapy in order to maximize the quality of life and independence of your child throughout their life.

Sometimes families are reluctant to contact a medical malpractice lawyer. It’s also not uncommon for parents to feel overwhelmed by the responsibilities they encounter in caring for their injured child and worried that they will not be able to help out in a lawsuit involving their child’s birth injury. Our birth injury attorneys and nursing staff will address these hesitations and concerns, so you can focus on your child and maximizing their care.

Most birth injury law firms will employ one or two nurses to assist the review of cases and medical research. But Miller Weisbrod Olesky offers an unmatched number of nurses and nurse-attorney employees support to both the birth injury attorneys and our clients.

Our team of registered nursing staff and nurse-attorneys bring a deep level of medical and personal insight to every client’s case. Our nursing team includes both an experienced labor and delivery nurse as well as an ICU nurse. Working closely with the rest of the team, they investigate the reasons behind a birth injury and how medical professionals breached their standard of care.

Linda Chalk

As a registered nurse, Linda practiced ICU nursing for 44 years while caring for a wide range of patient conditions. She has worked closely with founding partner Les Weisbrod for over 30 years, investigating and pursuing birth injury cases.

Along with DJ Weisbrod, Linda heads up the firm’s birth injury intake, screening, and medical literature research team. She personally screens all potential cases to ensure that medical issues have been addressed before we file lawsuits on behalf of birth-injured children and their families.

DJ Weisbrod

Before joining Miller Weisbrod, DJ practiced as a surgical nurse in various hospital and operative settings. She has been with the firm over 30 years.

DJ directs Miller Weisbrod’s birth injury intake and medical screening team. She has also served as firm founder Les Weisbrod’s trial nurse for all cases involving medical negligence and birth injury.

Linda Cuaderes

Linda Cuaderes is both a registered nurse and a licensed lawyer. Linda works exclusively in Miller Weisbrod’s Birth Injury and Medical Malpractice section. Linda acts as the firm’s patient advocate and liaison with our young clients and their parents.

Linda combines her legal and nursing experience along with her exceptional organizational talent and attention to detail to make sure each child we represent is provided the highest level of medical care and attendant care during the pendency of their case. Linda communicates with our parent clients regularly to monitor their birth injured child’s treatment, provide guidance as to additional care and therapies and when necessary assist them in obtaining specialized medical providers.

Linda was raised in Bartlesville, Oklahoma and completed her Bachelor of Science in Nursing with Honors at the University of Oklahoma. She started as an Oncology Nurse at Presbyterian Hospital in Oklahoma City, quickly becoming the Assistant Head Nurse of the Outpatient Endoscopy Unit. Linda then entered the University of Oklahoma College of Law.

Following graduation, Linda joined Les Weisbrod in the Medical Malpractice Section. After taking time off to raise her three lovely children, Linda returned to Miller Weisbrod and her passion of holding healthcare providers accountable for preventable errors. Linda is active in the American Association for Justice, Texas Trial Lawyers Association, Dallas Trial Lawyers Association, and the Texas Bar Association. Linda is an active member of the Birth Trauma Litigation Group and Medical Negligence Section of the American Association for Justice.

She is admitted to practice before the Texas Supreme Court and routinely works on cases pending throughout the United States. Linda has worked with child victims of birth injury, their parents and other victims of medical malpractice in Texas, New Mexico, Oklahoma, Arkansas, Louisiana, Iowa, Ohio, New York, Alabama, Georgia, Arizona, Utah and Missouri.

Education

• University of Oklahoma - School of Law, 1990, J.D. - Norman, Oklahoma
• University of Oklahoma - School of Nursing, 1985 - Norman, Oklahoma

Bar Admissions

• Texas - 1990

Areas of Practice

• Birth Injury/Birth Trauma
• Medical Malpractice

Associations & Memberships

• Texas Bar Association
• American Association of Justice
• Texas Trial Lawyers Association
• Dallas Trial Lawyers Association

Kristin Jones

Kristin combines her medical and legal training to provide invaluable, passionate service to parents struggling to care for their birth-injured children.

Families often have questions as they go through the birth injury lawsuit process. Kristin diligently identifies and investigates all medical issues so the birth injury attorneys at Miller Weisbrod can answer those questions Kristin ensures that our birth injured children’s medical records are thoroughly reviewed and organized. Miller Weisbrod’s birth trauma litigation attorneys and medical experts retained by the firm need her services while pursuing justice for our clients.

Kelly Kunkel

Kelly Kunkel was born and raised in Dallas, Texas. She has 15 years’ experience in hospital based High Risk Obstetrics and Labor and Delivery bedside nursing care. Kelly graduated with an Associate’s Degree in Nursing from El Centro College in December of 1990 and received her Bachelor’s Degree in Nursing from West Texas A & M University in 2008; graduating with honors.

In addition, Kelly has over 25 years’ experience in medical malpractice case management and litigation and has worked with David Olesky for over 22 years. After many years of assisting in defending healthcare providers and hospital systems in medical malpractice cases involving complex litigation matters related to birth injury, catastrophic injury and death, Kelly has proudly joined David Olesky in the national birth injury and medical negligence practice at Miller Weisbrod Olesky.

Why Should You Talk with the Knowledgeable Attorneys at Miller Weisbrod Olesky?

The only way to find out if you have a birth injury case is to talk to a lawyer experienced in birth injury lawsuits. It’s not uncommon that a birth related complication results in a preventable birth injury, including cerebral palsy, but it takes a detailed expert review by a birth injury attorney of the medical records from your child’s birth to determine if the birth injury was the result of medical malpractice.

At Miller Weisbrod Olesky, a team of committed lawyers, nurses and paralegals uses our detailed medical negligence case review process to assess your child’s potential birth injury case. We start by learning more about you and your child and the status of meeting/missing developmental milestones. Then we gather medical records to determine what happened before, during, and after your delivery. We call in skilled medical experts who review your records and let us know if they think medical errors could have caused your child’s injuries.

If we feel medical negligence caused or contributed to your child’s injuries, we meet with you to discuss how you can receive compensation from the medical professionals who made the errors. Our birth injury attorneys have recovered millions of dollars in settlements for families of children that have suffered a birth injury.

At no point in our legal intake process will we ask you to pay anything. The medical review of your case and the consultation are free. We only receive payment when you do.