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Key Features

  • One of the most common symptom complexes of the newborn

  • may result from cardiopulmonary and noncardiopulmonary causes

  • Most of the noncardiopulmonary causes can be ruled out by the history, physical examination, and a few simple laboratory tests.

  • Most common pulmonary causes of respiratory distress in the full-term infant are transient tachypnea, aspiration syndromes, congenital pneumonia, and pneumothorax

Clinical Findings

  • Tachypnea, respiratory rate > 60 breaths/min

  • Intercostal and sternal retractions

  • Expiratory grunting

  • Cyanosis in room air


  • Chest radiography, arterial blood gases, and pulse oximetry are useful in assessing the cause and severity of the distress


  • Supplemental oxygen sufficient to maintain a PaO2 of 60–70 mm Hg and an oxygen saturation by pulse oximetry (SpO2) of 92–96%

  • Oxygen should be warmed, humidified, and delivered through an air blender

  • Concentration should be measured with a calibrated oxygen analyzer

  • An umbilical or peripheral arterial line should be considered in infants requiring more than 45% fraction of inspired oxygen (FIO2) by 4–6 hours of life to allow frequent blood gas determinations

  • Noninvasive monitoring with pulse oximetry should be used

  • Other supportive treatment includes intravenous glucose

  • Unless infection can be ruled out, blood cultures should be obtained, and broad-spectrum antibiotics started

  • Volume expansion (normal saline) can be given in infusions of 10 mL/kg over 30 minutes for low blood pressure, poor perfusion, and metabolic acidosis

  • Intubation and ventilation

    • Should be undertaken if there is respiratory failure (PaO2 < 60 mm Hg in > 60% FIO2, PaCO2 > 60 mm Hg, or repeated apnea)

    • Peak pressures should be adequate to produce chest wall expansion and audible breath sounds (usually 18–24 cm H2O)

    • Positive end-expiratory pressure (4–6 cm H2O) should be used

    • Ventilation rates of 20–40 breaths/min are usually required

    • Goal is to maintain a PaO2 of 60–70 mm Hg and a PaCO2 of 45–55 mm Hg

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