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Respiratory Distress in


Ajay Ganesh J
• Tachypnea accompanied by chest retractions and
or grunt.
• Tachypnea = Respiratory rate more than 60/min.
• Early recognition and prompt treatment is
1. Respiratory
2. Non respiratory
1. Respiratory Causes
Causes Time of onset Remarks
Respiratory Distress 1st 6 hour of life Common in preterm
Syndrome neonates
Meconium aspiration First few hours of life Common in term, post term
syndrome and small for date babies;
history of meconium stained
Pneumonia Any age Often bacterial
Transient tachypnea of First 6 hours after birth Tachypnea with minimal
newborn distress
Persistent pulmonary Any age Severe distress, cyanosis
Pneumothorax Any age Sudden deterioration;
usually during assisted
Tracheoesophageal fistula Any age May show associated
polyhydramnios in
esophageal atresia
1. Non respiratory causes

Metabolic Hypothermia, hypoglycemia,

metabolic acidosis
CNS Asphyxia, cerebral edema,
Chest wall Asphyxiating thoracic
dystrophy, Werdnig-Hoffman
Cardiac CHF, congenital heart disese
Respiratory distress syndrome or
hyaline membrane disease
• Surfactant deficiency
• Alveoli tends to collapse due to reduced surface tension
during expiration.
• Increased work and less oxygenation during breathing.
• Increased pulmonary resistance and left to right shunt
through foramen ovale.
• Distress occurs in 1st 6 hours of life.
• Tachypnea, grunting, cyanosis, retractions, decreased
air entry.
• X ray confirms diagnosis.
• Continuous positive airway pressure.
• Intratracheal exogenous surfactant is the treatment
of choice in neonates.
• For 28 week newborns prophylactic surfactant is
Meconium Aspiration Syndrome
1. Aspirated meconium.
2. Atelectasis and emphysema.
3. Air leak syndromes like pneumothorax.
4. Respiratory failure.
Clinical Features
1. Respiratory distress in 1st few hours of life
deteriorating in next 24-48 hrs.
2. If untreated it can lead to respiratory failure.
3. Complications – Air leak syndromes, persistent
pulmonary hypertension.
4. Chest X ray shows B/L heterogenous opacities,
areas of hyperexpansion, atelectasis and air leak.
• Supportive care
• Oxygenation and ventilation
Persistent pulmonary
• Increased pulmonary vascular resistance resulting
in right to left shunt across foramen ovale.
• Due to persistent hypoxia and acidosis.
• Common conditions are MAS, diaphragmatic
• Severe respiratory distress and cyanosis.
• Echocardiography to rule out cardiac lesions.
• Ventilatory support and NO therapy is the
treatment of choice.
• E coli, S. aureus, K. pneumoniae
• X ray shows pneumonia
• Supportive care and antibiotic therapy.
• Usually ampicillin or cloxacillin with gentamicin is
Transient tachypnoea of newborn
• Self limiting disease
• Delayed clearance of fluid.
• X ray chest shows hyperexpanded lung fields,
prominent vascular markings and prominent
interlobar fissure.
• Oxygen treatment is adequate.
Chronic lung diseases or
bronchopulmonary dysplasia
• Barotrauma and oxygen toxicity.
• Damage to alveolar cells, interstitium and blood
• Inflammatory mediators causing leakage of water
and protein.
• Fibrosis and cellular hyperplasia in later stages.
• Even lead to respiratory failure.
• Prolonged oxygen therapy and ventilatory support.
• Needle aspiration and chest tube drainage.
• Usual cause is meconium aspiration syndrome.
• Cessation of respiration for 20s with or without
bradycardia and cyanosis.
• Cessation of respiration for shorter duration if there
is bradycardia or cyanosis.
• It could be central, obstructive or mixed causes.
• Central causes are apnea of prematurity, sepsis,
hypoglycemia, hypocalcemia.
• Supportive treatment and correction of underlying
Thank You