What Is Respiratory Distress Syndrome?

Respiratory distress syndrome (RDS) is among the most common comorbidities observed at birth in preterm infants.¹ Respiratory support for preterm infants with RDS often begins with CPAP—and early assessment for signs of CPAP failure is critical for prompt consideration of early surfactant treatment.^2-4*

CPAP failure—often defined as the need for mechanical ventilation within 72 hours after birth. CPAP failure may predict the need for early rescue application of exogenous surfactants⁵
Early rescue—defined as exogenous surfactant use within 2 hours of birth—may improve outcomes in preterm infants with RDS compared with delayed application more than 2 hours after birth^2,6†

*The European Consensus Guidelines on the management of RDS reflect the clinical practice standards and medications approved for use in EU hospitals; as such, certain recommendations may not be relevant to US clinical practice. US and EU patient populations and clinical practice standards are widely accepted to be distinct; therefore, there may be significant limitations to the extrapolation of certain data from EU studies to the US patient population.

^†It is important to note that early rescue may not be appropriate for all infants. Infants with RDS may vary markedly in the severity of respiratory disease, maturity, and presence of other complications, and thus it is necessary to individualize patient care.

93% of extremely preterm infants (22 to 28 weeks GA) developed RDS

Premature birth and RDS

RDS is a common syndrome that develops in preterm infants—in one study, 93% of preterm infants born at 22 to 28 weeks GA developed RDS.^1,7 Recognizing the earliest signs and symptoms of RDS is critical for timely treatment.⁴

Signs and symptoms of RDS^‡

Blue skin color (cyanosis)⁸
Apnea⁸
Flaring nostrils⁸

Progressively worsening lung disease^1,4
Rapid or shallow breathing^1,4
Grunting sounds with breathing^1,4

Intercostal retractions^1,4
Increased oxygen needs^1,4

^‡This is not an exhaustive list.

Preterm infants born at 32 to <37 weeks GA made up about 8% of total infants born in developed nations in 2010

RDS in older preterm infants

Consider the burden of RDS in older preterm infants when evaluating your patients.

Distribution of all preterm births according to GA^9§‖

Distribution of preterm births: Early preterm less than 28 weeks 5.2%, Moderate preterm 28 to 32 weeks 10.4%, Late preterm 32 to 37 weeks 84.3%

Image Description Collapse

Graph shows the distribution of preterm births, according to GA. Infants born at less than 28 weeks GA make up 5.2% of total preterm births, infants born between 28 and less than 32 weeks GA make up 10.4% of preterm births, and infants born between 32 and less than 37 weeks GA make up 84.3% of preterm births.

^§This meta-analysis compiled data from existing studies and should be interpreted with caution due to variability in study designs and populations. No direct head-to-head trials were conducted, and the findings do not constitute substantial evidence of efficacy or safety.

^‖GA subgroups based on meta-analysis of 345 data points from 41 countries with a total of 131,296,795 live births from 1990 to 2010.

RDS should not be underestimated in late preterm infants

RDS affects most preterm infants across the spectrum of GA. Even later preterm infants face significantly higher odds of developing RDS compared with term infants, and those who experience CPAP failure are at increased risk for serious complications.^5,10,11

Preterm infants born at 34 to <37 weeks GA are associated with increased risk of RDS and other respiratory morbidity compared with infants born at ≥37 weeks GA^12#

Preterm infants born at 34 to <37 weeks GA had 3.9 times the odds of RDS than infants born at ≥37 weeks GA (55.88% vs 24.51%; OR, 3.90; 95% CI, 2.15–7.09; P=0.000)^13#

^#The findings from the presented analyses include retrospective or pooled data, and results should be interpreted with caution due to study variability, limited generalizability, and lack of definitive evidence.

CPAP failure in preterm infants

Assess the potential for CPAP failure in preterm infants and recognize clinical signs.

Examine CPAP Failure

IMPORTANT SAFETY INFORMATION

CUROSURF^® (poractant alfa) is intended for intratracheal use only. The administration of exogenous surfactants, including CUROSURF, can rapidly affect oxygenation and lung compliance. Therefore, infants receiving CUROSURF should receive frequent clinical and laboratory assessments so that oxygen and ventilatory support can be modified to respond to respiratory changes.

CUROSURF should only be administered by those trained and experienced in the care, resuscitation, and stabilization of preterm infants.

Transient adverse reactions associated with administration of CUROSURF include bradycardia, hypotension, endotracheal tube blockage, and oxygen desaturation. These events require stopping CUROSURF administration and taking appropriate measures to alleviate the condition. After the patient is stable, dosing may proceed with appropriate monitoring.

Pulmonary hemorrhage, a known complication of premature birth and very low birth-weight, has been reported with CUROSURF. The rates of common complications of prematurity observed in a multicenter single-dose study that enrolled infants 700–2000 g birth weight with RDS requiring mechanical ventilation and FiO₂ ≥ 0.60 are as follows for CUROSURF 2.5 mL/kg (200 mg/kg) (n=78) and control (n=66; no surfactant) respectively: acquired pneumonia (17% vs. 21%), acquired septicemia (14% vs. 18%), bronchopulmonary dysplasia (18% vs. 22%), intracranial hemorrhage (51% vs. 64%), patent ductus arteriosus (60% vs. 48%), pneumothorax (21% vs. 36%) and pulmonary interstitial emphysema (21% vs. 38%).

INDICATION

CUROSURF^® (poractant alfa) Intratracheal Suspension is indicated for the rescue treatment of Respiratory Distress Syndrome (RDS) in premature infants. CUROSURF reduces mortality and pneumothoraces associated with RDS.

Please see Full Prescribing Information.

CI=confidence interval; CPAP=continuous positive airway pressure; EU=European Union; GA=gestational age; OR=odds ratio.

References: 1. Yadav S, Lee B. StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing. 2. Polin RA, Carlo WA; Committee on Fetus and Newborn; American Academy of Pediatrics. Pediatrics. 2014;133(1):156-163. 3. Dargaville PA, Aiyappan A, De Paoli AG, et al. Neonatology. 2013;104(1):8-14. 4. Sweet DG, Carnielli VP, Greisen G, et al. Neonatology. 2026:1-26. 5. Dargaville PA, Gerber A, Johansson S, et al; Australian and New Zealand Neonatal Network. Pediatrics. 2016;138(1):e20153985. 6. Bahadue FL, Soll R. Cochrane Database Syst Rev. 2012;11(11):CD001456. 7. Stoll BJ, Hansen NI, Bell EF, et al; Eunice Kennedy Shriver National Institute of Child Health and Human Development Neonatal Research Network. Pediatrics. 2010;126(3):443-456. 8. Kaneshiro NK. MedlinePlus Medical Encyclopedia. Updated July 29, 2025. Accessed April 13, 2026. https://medlineplus.gov/ency/article/001563.htm 9. Blencowe H, Cousens S, Oestergaard MZ, et al. Lancet. 2012;379(9832):2162-2172. 10. Hibbard JU, Wilkins I, Sun L, et al; Consortium on Safe Labor. JAMA. 2010;304(4):419-425. 11. Wang ML, Dorer DJ, Fleming MP, Catlin EA. Pediatrics. 2004;114(2):372-376. 12. Correia C, Rocha G, Flor-de-Lima F, Guimarães H. Minerva Pediatrica. 2018;70(4):345-354. 13. Molina TA. Open J Pediatr. 2024;14:22-35.