

Respiratory Distress in Newborn

 Neonatal Respiratory Distress 
Signs and symptoms
 Tachypnea (RR > 60/min)
 Nasal flaring
 Retraction
 Grunting
 +/- Cyanosis
 +/- Desaturation
 Decreased air entry
 
Down score
 
Neonatal Respiratory Distress Etiologies

Pulmonary Systemic
Metabolic (e.g.,
Anatomic
Transient tachypnea of hypoglycemia, hypothermia
the newborn (TTN) or hyperthermia)
Upper airway
metabolic acidosis obstruction
Respiratory distress
syndrome (RDS) Airway
anemia, polycythemia malformation
Pneumonia Rib cage anomalies
Cardiac
• Congenital heart disease;
Meconium aspiration cyanotic or acyanotic
Diaphragmatic
syndrome (MAS) • disorders
Congestive heart failure
• Persistent pulmonary (e.g., congenital
Air leak syndromes hypertension of the newborn diaphragmatic
(PPHN) hernia,
Pulmonary
hemorrhage diaphragmatic
Neurological (e.g., prenatal paralysis)
asphyxia, meningitis)
 Pulmonary
 1- Transient tachypnea of newborn

 2- Hyaline membrane disease

 3- Meconium aspiration syndrome (MAS)

 4- Pneumonia

 5- Air Leak Syndromes

Transient Tachypnea of Newborn

 TTN (known as wet lung) is a relatively mild,

self limiting disorder of near-term or term
 Delay in clearance of fetal lung fluid results in
transient pulmonary edema. The increased
fluid volume causes a reduction in lung
compliance and increased airway resistance.
 Transient Tachypnea of Newborn

Risk factors:
 Maternal asthma

 C- section

 Macrosomia, maternal diabetes

 Prolonged labor, Excessive maternal sedation

 Fluid overload to the mother,Delayed clamping of the

umbilical cord .
Transient Tachypnea of Newborn
 Usually near-term or term
 Tachypnea immediately after birth or within 6 hrs
after delivery, mild to moderate respiratory distress.
 These manifestations usually persist for 12-24 hrs, but
can last up to 72 hrs
 Auscultation usually reveals good air entry with or
without crackles
 Spontaneous improvement of the neonate is an
important marker of TTN.
Transient Tachypnea of Newborn
Chest x-ray :
 Prominent perihilar streaking (due to engorgement of
periarterial lymphatics)
 Fluid in the minor fissure

 Prominent pulmonary vascular markings

 Hyperinflation of the lungs, with depression of

diaphragm
 ► Chest x-ray usually shows evidence of clearing by 12-
18 hrs with complete resolution by 48-72 hrs
chest X-ray: Transient Tachypnea of Newborn

Fluid in the
fissure
General Management of Respiratory Distress

 Supplemental oxygen or MV, if needed.

 Continuously monitor with pulse oximeter.

 Obtain a chest radiograph.

 Correct metabolic abnormalities

(acidosis,hypoglycemia).
 Obtain a blood culture & begin an antibiotic
coverage (ampicillin + gentamicin)
General Management

 Provide an adequate nutrion. Infants with

sustained RR >60 breaths/min should not be fed
orally & should be maintained on gavage feedings
for RR 60-80 breaths/min, and NPO with IV fluids
or TPN for more severe tachypnea
 Pulmonary
 1- Transient tachypnea of newborn

 2- Hyaline membrane disease

 3- Meconium aspiration syndrome (MAS)

 4- Pneumonia

 5- Air Leak Syndromes

Respiratory Distress Syndrome
 Also called as hyaline membrane disease
 Most common cause of respiratory distress in
premature infants, correlating with structural &
functional lung immaturity.
 primarily affects preterm infants; its incidence is
inversely related to gestational age and
birthweight.
 15-30% of those between 32-36 weeks‘ gestation,
in about 5% beyond 37 weeks' gestation
Physiologic abnormalities
 Surfactant deficiency- increase in alveolar
surface tension.
 Lung compliance decreased to 10-20% of
normal
 Atelectasis…areas not ventilated
 Decrease alveolar ventilation
 Reduce lung volume
 Areas not perfused
 Surfactant Function
Normal Expiration Abnormal Respiration
With Surfactant Without Surfactant
 C o m p lian ce

M ax im a l vo lu m e
V o lu m e

P re ssu re O p en in g p ressures

17
Risk factors
 Prematurity

 Maternal diabetes

 Multiple births

 Elective cesarean section without labor

 Perinatal asphyxia

 Cold stress

 Genetic disorders
Decreased risk

 Chronic intrauterine stress

 Prolonged rupture of membranes
 Antenatal steroid prophylaxis
Clinical Manifestations
 Appear within minutes of birth may not be recognized for several
hours in larger preterm

 Tachypnea (>60 breaths/min), nasal flaring, subcostal and intercostal

retractions, cyanosis & expiratory grunting

 Breath sounds may be normal or diminished and fine rales may be

heard

 Progressive worsening of cyanosis & dyspnea. BP may fall; fatigue,

cyanosis and pallor increase & grunting decreases.

 Apnea and irregular respirations are ominous signs

 In most cases, symptoms and signs reach a peak within 3 days, after
which improvement occurs gradually.
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