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Respiratory distress syndrome in the newborn (discussed in detail in Chapter 54) is the most frequent problem that results in neonatal intensive care unit admission. It is essential to recognize, evaluate, and differentiate between the many possible causes of respiratory distress, including those that do not primarily involve the lung. The presenting symptoms and severity of these symptoms may alert the physician in a life-threatening situation.

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One or more of the following may characterize respiratory distress in the newborn: tachypnea, grunting, nasal flaring, and chest retractions. A newborn normally breathes at a rate of 30 to 60 breaths per minute. A newborn with tachypnea may breathe at a faster rate to maintain adequate ventilation and may attempt to decrease airway resistance by flaring the nares. The infant may try to maintain lung volume by partially closing the glottis during expiration, thereby producing grunting sounds. Chest retractions may occur with parenchymal lung disease or an obstructed airway. Additional signs such as cyanosis, gasping, apnea, stridor, or choking should alert the physician of a more severe respiratory problem. Respiratory distress in the newborn is a common presentation for a wide variety of disorders shown in Table 50-1.

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Table 50-1. Causes of Respiratory Distress in the Newborn Infant
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Transient tachypnea of the newborn (TTN) is a self-limited, usually benign disease, affecting the term infant and late-preterm infant soon after birth. Avery and coworkers described the clinical and radiographic features of this condition in 1966 and attributed it to a delayed absorption of fetal lung fluid.1 More recently, Bland2,3 described TTN as a persistent postnatal pulmonary edema, since some of the fluid may enter the lungs from the pulmonary circulation postnatally. TTN occurs in approximately 11 infants per 1000 live births and is more common in males. It is associated with cesarean section delivery,4 the use of maternal labor analgesia or anesthesia, gestational diabetes, and perinatal asphyxia.

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Pathogenesis

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Fetal lung fluid is essential for normal lung development, is a secretion intrinsic to the lung, and is not ...

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