Common Respiratory Disorders of the Newborn
Arthur E. Kopelman MD1
Oommen P. Mathew MD1
1 Professor of Pediatrics, East Carolina University School of Medicine, Greenville, NC.
Respiratory distress is a frequently encountered problem in the first few days of life. The general pediatrician must assess the infant's condition, make a tentative diagnosis, institute appropriate care, and decide whether to transfer the infant to a neonatal intensive care unit. The decision to transfer an infant should be based on the interest and training of the physician as well as on readily available resources for optimal management. In general, any infant who needs mechanical ventilation for more than a few hours should be transferred to a regional intensive care nursery.
An infant who is in respiratory distress of any cause may present with tachypnea, nasal flaring, sternal and intercostal retractions, cyanosis, and even apnea. The differential diagnosis of respiratory disorders in the newborn is extensive and includes disorders of the major airways, diseases of the pulmonary parenchyma, and rib cage abnormalities. Review of the history of pregnancy, labor, delivery, and resuscitation; careful physical examination; analysis of laboratory tests such as blood gases, hematocrit, and blood glucose; and evaluation of a chest radiograph usually permit a tentative diagnosis. Additional challenges arise when an infant who has chronic lung disease is returned to the community hospital for continuing care.
This review covers three of the most common forms of neonatal respiratory distress: transient tachypnea of the newborn (TTN), respiratory distress syndrome (RDS), and bronchopulmonary dysplasia (BPD).
