Neonatal Respiratory Distress

Tachypnea
Decreased air entry
Retractions
Grunting
Stridor
Nasal flaring
Decreased gas exchange hypoxemia, cyanosis
Clinical Manifestations
Respiratory distress is common immediately after birth as part of the transition to
extra-uterine life.
However, persistent problems lead to significant morbidity and mortality in the
neonatal period.
Physiological changes during delivery
These changes ultimately redirect gas exchange from
the placenta to the lung:

Replacement of alveolar fluid with air

Onset of regular breathing

ncrease in pulmonary blood flow

~!" of neonates re#uire resuscitative efforts$
Differential diagnosis
Common etiologies

Transient tachypnea of newborn !TTN"

#econium aspiration syndrome !#$S"% full&term

'ersistent pulmonary hypertension !''("% full&term

Respiratory distress syndrome !RDS"% pre&term

'neumonia

)ongenital heart disease

Transient tachypnea of ne%&orn
'athophysiology%
nade*uate alveolar fluid clearance at birth mild pulmonary
edema

)linical features%
Tachypnea beginning shortly after birth+ self&resolves by day , of
life

Diagnostic features%
)-R showing increased interstitial mar.ings+ fluid in the
fissures

#anagement%
Supplemental O,+ )'$'
Meconium aspiration syndrome
'athophysiology%
$irway obstruction+ chemical pneumonitis+ inactivation of lung
surfactant due to meconium

)linical features%
/ariable% mild distress severe hypoxemia
01arrel chest2 with rales 3 rhonchi

Diagnostic features%
)-R showing areas of atelectasis alternating %ith areas of
hyperinflation

#anagement%
Suctioning of the airways+ supplemental O,
Persistent pulmonary 'TN
'athophysiology%
$bnormally elevated pulmonary vascular resistance+ causing
right&to&left shunting of blood

)linical features%
Respiratory distress in first ,4h of life5 cyanosis !labile 'aO,"5
prominent precordial impulse+ narrowly split S, with ',
accentuation

Diagnostic features%
Pre(post)ductal *+ gradient ,!"

#anagement%
Supplemental O,+ inhaled NO+ 6 ventilatory support
Respiratory distress syndrome

'athophysiology%
nsufficient pulmonary surfactant due to prematurity

)linical features%
Respiratory distress at birth+ hypoxemia+ respiratory acidosis

Diagnostic features%
)-R showing -ground glass. atelectasis+ 3 air
bronchograms

#anagement%
$ntenatal steroids+ mechanical ventilation+ endotracheal
surfactant replacement
Pneumonia

#ost common neonatal infection

)linical features%
Respiratory distress+ lethargy+ poor feeding+ 7aundice+ apnea+
temperature insta&ility
-
8arly&onset% G1S+ (S/
-
9ate&onset% Chlamydia+ RS/

Diagnostic features%
)-R showing locali:ed+ diffuse !G1S"+ or 0white&out2 !in utero
infection"

#anagement%
8mpiric antibiotics until pneumonia or sepsis is ruled out
Congenital heart disease

)linical features%
Respiratory distress at birth+ hypoxemia;cyanosis+
hyperactive precordial impulse+ gallop rhythm+ poor
peripheral perfusion+ hepatomegaly+ single /+, no
correction of Pa*+ %ith !!" oxygen

Diagnostic features%
)-R showing cardiomegaly, increased pulmonary
vascular mar0ings

#anagement%
Surgical repair
Congenital heart disease
Than0 you1
References:
Adams JM, Stark AR. Persistent pulmonary hypertension of the newborn. In: Upo!ate, Post " #$d%, Upo!ate, "altham,
MA.
Aly &. Respiratory disorders in the newborn: identifi'ation and dia(nosis. Pediatrics in Review, 25#)%, *+,-*+..
Martin R, Saker /. 01er1iew of neonatal respiratory distress: disorders of transition. In: Upo!ate, Post " #$d%,
Upo!ate, "altham, MA.
Ro(ido M, Sola A, Miller 2. 34eonatolo(y.5 BRS Pediatrics. $d. 2J 6rown, $d. 2 Miller. 2"", *++7. .8-,,..
Saker /, Martin R. Pathophysiolo(y and 'lini'al manifestations of respiratory distress syndrome in the newborn. In: Upo!ate,
Post " #$d%, Upo!ate, "altham, MA.