Overview of Perinatal Respiratory Disorders
Symptoms and signs of respiratory distress vary and include nasal flaring; intercostal, subcostal, and suprasternal retractions; weak breathing, irregular breathing, or a combination; tachypnea and apneic spells; cyanosis, pallor, mottling, delayed capillary refill, or a combination; and hypotension. In neonates, symptoms and signs may be apparent immediately on delivery or develop minutes or hours afterward.
Respiratory distress in neonates and infants has multiple causes (see Table: Causes of Respiratory Distress in Neonates and Infants).
Causes of Respiratory Distress in Neonates and Infants
There are several significant differences in the physiology of the respiratory system in neonates and infants compared with that of older children and adults. These differences include
Also, infants’ smaller airway caliber gives increased airway resistance, and absence of collateral ventilation increases tendency toward atelectasis. Yet, other principles of respiration are similar in adults and children.
Evaluation starts with a thorough history and physical examination.
History in the neonate focuses on maternal and prenatal history, particularly gestational age, maternal infection or bleeding, meconium staining of amniotic fluid, and oligohydramnios or polyhydramnios.
Physical examination focuses on the heart and lungs. Chest wall asymmetry or sunken abdomen suggests diaphragmatic hernia (see Diaphragmatic Hernia). Asymmetric breath sounds suggest pneumothorax (see Pulmonary Air-Leak Syndromes: Pneumothorax), pneumonia (see Neonatal Pneumonia), or asthma. A displaced left apical impulse, heart murmur, or both suggest a congenital heart defect (see Overview of Congenital Cardiovascular Anomalies). Assessment of BP and femoral pulses may identify circulatory collapse with or without congenital defects. Poor capillary refill reflects circulatory compromise.
In both neonates and infants, it is important to assess oxygenation and response to O2 therapy by pulse oximetry or blood gases. Chest x-ray also is recommended.