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• Causes of respiratory distress in newborn

  • Respiratory distress syndrome
  • Meconium aspiration syndrome
  • Congenital pneumonia
  • Neonatal sepsis
  • Congenital heart disease
  • Diaphragmatic hernia
  • Lung hypoplasia
• Respiratory distress syndrome (RDS)


  Most common respiratory illness in NICU<|>Occur in premature neonate<|>Surfactant deficiency
• Risk factors for RDS

  • Asphyxia and stress
  • Male
  • Acidosis
  • DM mother
• Surfactant


  Produced by type II pneumocytes<|>Laminar body formation starts at 22 weeks, matures at 34-36 weeks<|>Phosphatidylcholine ~70%<|>Phosphatidylglycerol<|>Surfactant specific protein<|>Recycling and regeneration (including externally given surfactant)
• Functions of surfactant


  • Decrease surface tension at air liquid level
  • Equalize tension in alveoli of different size
  • Increase in lung compliance
• Absence of surfactant


  Cause RDS<|>Pulmonary hypertension
• Physiologic abnormalities in RDS

  • Lung compliance 10-20% of normal
  • Atelectasis - areas not ventilated
  • Areas not perfused
  • Decrease alveolar ventilation
  • Reduce lung volume
• Signs of respiratory distress

  • Tachypnea
  • Retraction
  • Grunting
  • Nasal flaring
  • Apneic episode
  • Cyanosis
  • Extremities puffy or swollen
• Acid-base changes in RDS

  pH ↓<|>PaCO2 ↑<|>PaO2 ↓<|>HCO3 ↓<|>Base deficit
• Chest X-ray findings in RDS


  Ground glass appearance<|>Reticulogranular<|>With air bronchograms
• Treatment for respiratory distress

  • Surfactant administration
  • Prevention
  • Rescue
  • Supportive
  • Thermal
  • Fluid and nutrition
  • Oxygen
  • Mechanical ventilation
• Complications of respiratory distress

  • Pneumothorax
  • PDA
  • Chronic lung disease
  • Sepsis
• Meconium aspiration syndrome


  First stool that constitutes the GI epithelium and secretion during fetal life<|>Stress and intra-uterine meconium in term & post term infants<|>Gasping cause the aspiration<|>Chemical pneumonitis<|>Same signs of distress and PPHN<|>Treatment mainly supportive
• Congenital pneumonia


  • Sepsis risk factors - PROM, Prematurity, Maternal fever, discharge, abdominal pain, leukocytosis, Colonization with GBS
  • It usually manifest after hours or days of birth
  • Same signs of RD
  • X-ray findings
• Transient tachypnea of newborn


  Term<|>Caesarian delivery<|>Lung fluid retension<|>Usually tachypnia without O2 requirement<|>Resolve in 48-72 hours<|>X-ray - typically reticulogranular appearance but can be any type