Newborn Respiratory Disorders

Jamie B. Warren, MD* 2. JoDee M. Anderson, MD, MEd* 1. *Oregon Health & Science University, Portland, Ore. After completing this article, readers should be able to: 1. Evaluate and diagnose the most common causes of respiratory distress in the newborn period. 2. Differentiate between the normal results of a newborn chest radiograph and the radiographic patterns that reflect neonatal respiratory distress syndrome, meconium aspiration syndrome, retained fetal lung liquid syndrome, and neonatal pneumonia. 3. Recognize subglottic stenosis as a complication of endotracheal intubation. 4. Distinguish between pulmonary disease and cyanotic congenital heart disease as a cause of hypoxemia and acidosis in the neonate. 5. Discuss common complications of various respiratory disorders (such as meconium aspiration syndrome) and the untoward effects of specific therapies (intubation and mechanical ventilation). 6. Describe how chronic lung disease may result from meconium aspiration. Neonatal respiratory disorders account for most admissions to intensive care units in the immediate newborn period. Newborns in respiratory distress must be evaluated promptly and accurately; occasionally, neonatal respiratory distress is life-threatening and requires immediate intervention. The causes of respiratory distress in the newborn are numerous and are due to pulmonary or nonpulmonary processes. (1) Initial stabilization of the neonate, through management of the airway, breathing, and circulation, takes precedence over determining the cause. A thorough initial assessment, including maternal and neonatal history, physical examination, and appropriate use of diagnostic tests, is essential to diagnosing the cause of respiratory distress. Respiratory distress in the neonate most commonly presents as one or all of the following physical signs: tachypnea, grunting, nasal flaring, retractions, and cyanosis. (2) A normal respiratory rate in a newborn is between 30 and 60 breaths/min; tachypnea is classified as respiratory rates greater than 60 breaths/min. Patients born with surfactant deficiency and poorly …