Common Respiratory Problems in Newborns

Respiratory distress is a common issue requiring neonatal intensive care unit (NICU) admission and is a leading cause of neonatal mortality. The causes may be related to respiratory or non-respiratory conditions.

Causes of Respiratory Distress in Newborns:

A) Respiratory Causes:

• Hyaline Membrane Disease (HMD) – seen in preterm infants
• Transient Tachypnea of the Newborn (TTN)
• Meconium Aspiration Syndrome (MAS)
• Neonatal Pneumonia
• Pneumothorax (Air leakage in the pleural space)
• Pulmonary Hemorrhage

B) Non-Respiratory Causes:

• Congenital heart defects
• Persistent pulmonary hypertension of the newborn (PPHN)
• Birth asphyxia and intracranial hemorrhage
• Diaphragmatic hernia
• Hypoglycemia
• Acidosis
• Temperature instability
• Sepsis
• Blood disorders such as anemia

Nurse’s Assessment:

1. History Collection:
• Gestational age
• Mode of delivery (normal or cesarean)
• History of previous siblings with respiratory distress
• Maternal conditions (diabetes, hypertension, infections)
• Presence of meconium-stained amniotic fluid
2. Physical Examination:
• Signs of Respiratory Distress:
• Rapid breathing (≥60 breaths per minute)
• Retractions (chest pulling inward during breathing)
• Grunting sounds during exhalation
• Cyanosis or pale, mottled skin
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Downs' Score for Assessing Respiratory Distress:

Interpretation:

• Score < 4: No respiratory distress
• Score 4-7: Mild to moderate respiratory distress
• Score > 7: Severe respiratory failure requiring arterial blood gas analysis and possible mechanical ventilation

Required Tests:

• Chest X-ray
• Arterial blood gas analysis
• Complete blood count
• Blood culture

Treatment:

• Oxygen therapy
• Continuous Positive Airway Pressure (CPAP)
• Mechanical ventilation if necessary
• Surfactant therapy as prescribed
• Intravenous antibiotics if sepsis is suspected
• IV fluids or total parenteral nutrition

Nursing Care:

• Continuous monitoring of vital signs and oxygen saturation
• Maintaining proper body temperature
• Keeping the airway open (correct positioning with a small towel under the shoulders)
• Evaluating breath sounds and chest movements
• Administering oxygen as per medical instructions (maintaining SpO₂ at 89-93%)
• Suctioning secretions when needed and documenting their characteristics (color, amount, viscosity)
• Monitoring blood glucose levels
• Preparing IV fluids as needed
• Keeping emergency equipment ready (oxygen source, ambu bag, laryngoscope, endotracheal tubes, suction device)