Respiratory Distress in the Newborn

1. See Also
   1. Newborn Resuscitation
   2. Neonatal Distress Causes
2. Causes
   1. See Neonatal Distress Causes
   2. Common
      1. Transient Tachypnea of the Newborn
      2. Respiratory Distress Syndrome in the Newborn
      3. Meconium Aspiration Syndrome
   3. Less common
      1. Delayed transition
      2. Pneumonia (e.g. Group B Streptococcal Pneumonia)
      3. Neonatal Sepsis
      4. Persistent Pulmonary Hypertension of the newborn
      5. Pneumothorax in the newborn
      6. Anemia
      7. Congenital malformations
         1. Pulmonary hypoplasia
         2. Diaphragmatic Hernia
         3. Esophageal atresia
         4. Airway obstruction (e.g. Choanal Atresia, Tracheomalacia, Macroglossia)
         5. Congenital heart disease
      8. Neurologic conditions
         1. Hydrocephalus
         2. Intracranial Hemorrhage
         3. Maternal agents causing Sedation and central respiratory depression
      9. Metabolic disorders
         1. Hypoglycemia
         2. Hypocalcemia
         3. Inborn Errors of Metabolism
3. Evaluation
   1. See Newborn History
   2. See Newborn Exam
      1. Observe for apnea or Tachypnea
      2. Observe for cyanosis
      3. Auscultate for cardiac murmurs suggestive of Congenital Heart Defect
      4. Auscultate lungs for asymmetry suggestive of Pneumonia or Pneumothorax
4. Labs
   1. Blood Culture
   2. Capillary gas (sufficient in most cases unless high oxygen needs) or Arterial Blood Gas
   3. Complete Blood Count with platelets and differential
   4. Serum Glucose
5. Imaging
   1. Chest XRay
6. Diagnostics
   1. Pulse oximetry
7. Management
   1. See Newborn Resuscitation
   2. General Measures
      1. Supplemental Oxygen
      2. Mild Tachypnea can be observed for 10-20 minutes
      3. Withold oral feedings when Respiratory Rate is rapid (>80/minute)
      4. Consider neonatology consultation
   3. Follow specific management for suspected causes
      1. See each specific condition for guidelines
      2. Antibiotics for suspected Neonatal Sepsis or Neonatal Pneumonia
      3. Surfactant for Respiratory Distress Syndrome in the Newborn
      4. Needle decompression of Pneumothorax
   4. Indications for NICU transfer or consultation
      1. Condition worsens or fails to improve within 2 hours
      2. Supplemental Oxygen requirements >40%
      3. Chest XRay abnormalities
8. References
   1. Hermansen (2007) Am Fam Physician 76(7): 987-94
   2. Hein (1998) J Fam Pract 46:284-9