Respiratory Distress in

Newborn
= Abnormal respiratory signs in
neonates
 Tachypnea vs
Respiratory distress
Tachypnea alone means an increased
respiratory rate of >60/min in a quiet
resting baby

Distress indicates more severe form of

respiratory disease and it is associated
with retractions and grunting
 Definition
Respiratory distress :
Presence of at least 2 of the following
criteria:
Respiratory rate >60 / min
Subcostal /intercostal
retractions /nasal flaring/cyanosis
Expiratory grunt /groaning
Respiratory Distress Signs
 An attempt to maintain
minute
ventilation and prevent
lung collapse
Respiratory Rate:
Tachypnoe
a Birth to 2 months: 60 or
more
2 to 12 months: 50 or more
12 months to 5 years: 40 or
more
 A reflection of noncompliant
or
stiff lungs and compliant chest
wall

Due to negative intrapleural

pressure generated between the
contraction of diaphragm,
Tachypnoe respiratory muscles and the
Retractions mechanical properties of lung
a
and chest wall

Suprasternal Retraction- SSR

Intercostal Retraction -ICR
Subcostal Retraction- SCR
 Low pitched expiratory
sound.

Expiration through partially

closed vocal cords to increase
airway pressure and lung
volume resulting in improved
ventilation-perfusion (V/P) ratio
Grunting

Protective phenomenon to
prevent collapse of alveoli: PEEP
 An attempt to
decrease airway
resistance and take in
more oxygen

Narrow nasal space

Nasal contributes to total lung
Flaring resistance

Nasal flaring decreases

the work of breathing
 A result of increasing
hypoxemia
Blues colouration of skin and
Moucus memrane due to
excessive desaturated HB in
blood (>5gm/dl desaturated HB
in blood)

Clinical detection of cyanosis

depends on total amount of
Cyanosi desaturated HB in blood
s Anaemic infants may have low
PaO2 that is missed clinically
Polycythaemic infants with
normal PaO2 can appear cyanotic
Upper Airway Obstruction

Respiratory
Rib cage anomalies
Neuromuscular
Congenital
PPHN
Metabolic
Hypothermia
Hypoglycaemia
Polycythaemia
Anaemia
Shock
Intracranial
acidosis
Diaphragmatic
Heart
Birth
diseases
Trauma/
DiseasesEncephalopathy
Hernia/
Transient Tachypnea of
Newborn(TTN)

Tachypnea immediately after

birth with other predictable
signs of respiratory distress.

Most common cause of

respiratory distress.
 Pathophysiology

Residual fluid in lung tissues due

to delay resorbtion of fetal lung
fluid.
Decrease pulmonary compliant,
tidal volume and increase dead
space.

Severe cases Interfere with normal

postnatal fall in pulmonary
vascular resistance-PPHN
 Symptoms can last few hours to
two days.

Chest radiography shows

diffuse parenchymal infiltrates
and intralobar fluid accumulation.
X-ray

Fluid in the
fissure
 Respiratory Distress
Syndrome(RDS)
Respiratory distress shortly after
birth commonly in premature
baby due to surfactant
deficiency.
Also called as hyaline membrane
disease

Incidence of RDS is inversely

proportional to gestational age.
 PHYSIOLOGY

Surfactant
synthesied in
type II
pneumocytes

Production is
marked at 30-
34 wks of
gestation
Function of Surfactant
- Reduces suface tention
- Facilitate expansion of lung during
inspiration
- Prevents atelectasis during expirations
COMPOSITION OF HUMAN
SURFACTANT
PATHOPHYSIOLOG
Y
 Meconium Aspiration
Syndrome(MAS)
Aspiration of meconium mixed
amniotic Fluid.

Meconium
GI secretions, cellular debris, bile,
pancreatic juice, mucus, lanugo
hairs, vernix, blood.