Respiratory Distress in Neonates (Newborns) • Respiratory rate of more than 60 per minute, dyspnoea, with chest indrawing and sternal
retraction persisting for long standing period
• A characteristic expiratory or inspiratory grunt and cyanosis may or may not be present
• May be because of a predominantly medical or surgical pathology, or may be a medical
condition superimposed on a surgical pathology.
Causes of respiratory distress in neonates{New borns}
• Respiratory distress syndrome (surfactant deficiency, prematurity)
• Meconium aspiration pneumonia
• Septicaemia
• Pulmonary haemorrhage
• Amniotic fluid aspiration
• Congenital heart diseases
• Infection (CMV, herpes simplex
Treatment of respiratory distress in neonates.
• Clear airway and give oxygen if available
• Keep warm
• Give broad spectrum antibiotics (e.g. Ampicillin IM)
• Expressed breast milk, feed by cup and spoon or via NG tube .
Respiratory Distress Syndrome (RDS)
RDS is a generic term used to describe progressive signs of respiratory distress that are
noted soon after birth (and persist more than 4 hrs) including:
o Tachypnea
o Expiratory grunting (from partial closure of glottis)
o Subcostal and intercostal retractions
o Cyanosis
o Nasal flaring
• RDS, also known as hyaline membrane disease (HMD), is caused by pulmonary
surfactant deficiency in the lungs, most commonly in neonates born < 37 wk of gestation
• Risk increases with degree of prematurity
• Extremely immature neonates may develop apnoea and/or hypothermia
• RDS may occur with increased frequency in the following infants:
o White male infants
o Infants of diabetic mothers
o Infants born by caesarean section
o Second-born twins
o Infants with a family history of RDS
• Incidence of RDS decreases with:
o Use of antenatal steroids
o Maternal hypertension
• Secondary surfactant deficiency, so RDS may occur in infants with
o Intrapartum asphyxia
o Pulmonary infections (e.g. group B beta-haemolytic streptococcal pneumonia)
o Meconium aspiration pneumonia
o Congenital heart disease
o Pulmonary haemorrhage
o Amniotic fluid aspiration.
Clinical Features of respiratory disress syndrome.
• Tachypnoea (respiratory rate >60 /minutes)
• Apnoea
• Chest indrawing
• Nasal flaring
• Grunting
• Cyanosis
• Sequelae of RDS include septicaemia, PDA, apnoea/bradycardia, retinopathy of
prematurity, failure to thrive, IVH, and other brain lesions with associated
neurodevelopmental handicaps.
Treatment of respiratory disress syndrome
• Clear airway and ensure adequate breathing
• Keep warm
• Give oxygen if available
• Give broad spectrum antibiotics (e.g. Ampicillin/Cloxacilin and gentamycin IM)
• Expressed breast milk, feed by cup and spoon or via NG tube