Neonatal respiratory distress: diagnostic approach

Overview & Definition

Neonatal respiratory distress is the clinical syndrome of laboured breathing in the first hours to days of life, defined by tachypnoea (respiratory rate persistently above 60 per minute), increased work of breathing (subcostal and intercostal recession, nasal flaring, grunting), and impaired gas exchange manifested as hypoxaemia, hypercapnia, or both. It is the single most common reason for neonatal unit admission, affecting roughly 7% of all liveborn term and near-term infants and the overwhelming majority of very preterm infants. [1]

The diagnostic task at the bedside is not merely to confirm that an infant is in distress but to distinguish among the mechanisms causing it — surfactant-deficient lung disease (respiratory distress syndrome, RDS), retained fetal lung liquid (transient tachypnoea of the newborn, TTN), meconium aspiration, neonatal pneumonia or sepsis, structural thoracic or airway pathology, congenital heart disease, and systemic or metabolic derangements — because each demands a different intervention within the first golden hour. [1] [5]

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