Respiratory Disorders of the Newborn
Respiratory distress has a short differential
The preterm lung is surfactant-deficient, leading to respiratory distress syndrome with grunting, retractions, and hypoxemia; chest radiography shows low volumes, ground-glass opacities, and air bronchograms. Antenatal steroids and early CPAP reduce severity, and exogenous surfactant is used when FiO2 requirements rise. Transient tachypnea of the newborn follows delayed fluid clearance, often after cesarean delivery, and resolves. Meconium aspiration syndrome causes patchy infiltrates and air trapping; pneumothorax can complicate any respiratory disorder. Persistent pulmonary hypertension presents with labile hypoxemia and a pre/postductal saturation difference; inhaled nitric oxide is standard for term infants. Bronchopulmonary dysplasia is a chronic outcome of prematurity, ventilation, and oxygen.
Traps: attributing all cyanosis to lung disease; missing pneumothorax when an infant suddenly deteriorates; overusing antibiotics without reassessing; and failing to recognize that apnea of prematurity is treated with caffeine and respiratory support, not solely stimulation.
Worked example: a 30-week infant develops grunting at 2 hours, needs 40% oxygen, and has a ground-glass radiograph. CPAP is started, surfactant is given, and oxygen is weaned to target saturations. The team avoids aggressive suctioning and monitors for air leak.
Rule of thumb: “Preterm plus grunting equals RDS until proven otherwise; escalate from CPAP to surfactant when oxygen needs climb.”