Newborn respiratory distress

Question 1

Respiratory distress syndrome

Answer 1

Predominately pre-term (1% term)
Presents very soon after birth with respiratory distress: tachypnoea, recession, grunting, nasal flaring, reduced breath sounds, cyanosis
May rapidly progress to fatigue, apnoea and hypoxia
Surfactant replacement therapy, O2 and supportive management

Question 2

Transient tachypnoea of the newborn

Answer 2

Benign, self-limiting
Caused by delay in normal reabsorption of lung fluid at birth
Risk factors: C-section, infants of diabetic mums
CXR - streaky appearance with fluid in horizontal fissure
Resolves withing 48 hours

Question 3

Meconium aspiration

Answer 3

10% term neonates pass meconium before birth
Rare in preterm babies
Associated with fetal distress (ie hypoxia)
Results in bronchial obstruction and collapse, chemical pneumonitis and secondary infection => respiratory distress
High incidence of air-leak (pneumothorax/pneumomediastinum) and pulmonary hypertension
Suction, oxygen, antibiotics, surfactant, inhaled NO, steroids