Neonatal and Congenital Lung Disease
Core concepts
Respiratory distress in the newborn has age- and gestation-specific causes. Respiratory distress syndrome results from surfactant deficiency in preterm infants and causes grunting, retractions, ground-glass lungs, and air bronchograms; antenatal corticosteroids and surfactant improve outcomes. Transient tachypnea of the newborn occurs in term or near-term infants, often after cesarean delivery, with tachypnea and fluid in the fissures; it resolves over 24–72 hours. Meconium aspiration syndrome occurs in term or post-term infants, with risks of persistent pulmonary hypertension and air leak; routine intrapartum suctioning is not recommended. Congenital diaphragmatic hernia presents with a scaphoid abdomen and bowel in the chest, with pulmonary hypoplasia; use gentle ventilation and nasogastric decompression. Congenital pulmonary airway malformation and bronchopulmonary sequestration are often diagnosed antenatally. Tracheoesophageal fistula causes drooling, choking with feeds, and cyanosis; stop feeds and evaluate. Oligohydramnios can cause pulmonary hypoplasia.
Traps
Do not confuse transient tachypnea with respiratory distress syndrome. Not all term distress is transient tachypnea. Congenital diaphragmatic hernia may have seemingly clear breath sounds. Overvigorous ventilation worsens pulmonary hypoplasia. Not every congenital lung lesion requires surgery.
Worked example and rule of thumb
A term infant born by elective cesarean has tachypnea, mild hypoxemia, and fluid in the minor fissure on chest radiograph; this is transient tachypnea of the newborn and should improve within 48–72 hours. Rule of thumb: preterm plus ground-glass lungs suggests respiratory distress syndrome; term plus wet fissures suggests transient tachypnea.