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Respiratory Distress in Neonates

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Respiratory distress is a result of immature development of the lungs. This article will give details about the causes and management of the condition.

Medically reviewed by

Dr. Sajeev Kumar

Published At August 23, 2022
Reviewed AtMarch 17, 2023

What Is Respiratory Distress in Neonates?

For a fetus to develop internal organs in the mother’s womb, 40 weeks of pregnancy is required. Neonatal respiratory distress is often seen in preterm babies with a gestation period of 37 weeks. Owing to genetic factors and environmental factors, the growth of the fetus is sometimes interrupted. And this interruption results in birth defects that cause many complications in the health of newborns. One of these abnormalities is preterm birth of babies that are caused by a genetic abnormality or other physiological factors. Preterm babies are born at the 37th week of gestation, which hampers the process of the development of internal organs. They are born with many developmental anomalies such as low birth weight, neurological issues, abnormal motor senses, underdeveloped internal organs, and disabilities. Respiratory distress affects almost 7% of all term neonates, especially the ones with preterm birth.

Due to the severity of the condition, newborns are required to undergo a 24 hours observation period in the hospital (NICU). These babies are not only born with underdeveloped organs, but also many other health-related issues. The severity of this condition depends on the gestational period’s count; the more premature the baby, the more severe the condition. Babies with respiratory distress show signs of not developed lungs, which plays a very crucial role in life as it develops the breathing pathway. The surfactant is released from the lungs in the 26th week to help and provide a surface tension barrier to keep the alveoli from collapsing from the exhalation of oxygen. With increased age, the amount of surfactant in the lungs is also increased. However, in complications like preterm birth, the baby's organs are not developed fully, and also, in particular, the surfactant is not developed from the lungs in the proper amount, and as a result, the newborn faces difficulties in breathing and lungs collapse.

On the contrary, after the birth of a full-term baby at 40 weeks, the gestation period, the first four hours, are very crucial. During this time, the infant is exposed to an extrauterine environment where the internal organs are adapting to the external environment for the first time, which makes them vulnerable to respiratory diseases and other infections. There is only one key to solving the problem, early diagnosis to get prompt treatment.

What Causes of Respiratory Distress in Neonates?

  • There are a plethora of conditions that are caused by a few reasons: maladaptation to the external environment after birth, developmental malformation, congenital abnormalities, or acquired conditions.

  • During embryonic development, if any stage is interrupted, it causes a birth defect in the fetus. Likewise, if there are any interruptions that happen during the developmental stage of the lungs, there are chances of the fetus getting underdeveloped lungs. In the 26th week, surfactants are being formed by the lungs to support breathing. Premature birth at 37th week has immature lungs lacking enough surfactant, which is essential for keeping the airway open for the breathing process. Not enough surfactant in the lungs causes alveoli to collapse, resulting in respiratory distress in neonates.

  • As the condition gets worse, the oxygen intake of newborns declines and carbon dioxide builds up in the bloodstream; hence the acidity of the blood increases. Impurity in the blood causes the organ to deteriorate, and as a result, this condition could be threatening if not treated on time.

  • Another developmental malformation that causes respiratory distress is a tracheoesophageal fistula, an abnormal mass of pulmonary tissue, and bronchogenic cysts. Additionally, until the age of 5 years, the lungs are still in the developmental phase, and there are chances of a child developing the same conditions at a later age as well. Neonatal respiratory distress can also be a result of a genetic anomaly with organ development. Sometimes it is seen that if any of the siblings have respiratory distress, there are chances of a newborn developing the same condition.

  • Furthermore, if a mother has any immunocompromised condition like diabetes, there are chances of neonates developing respiratory distress. Also, if the mother is in an emergency situation where before the baby’s full term, the labor has to be induced, there are chances of a newborn having respiratory distress at birth. Multiple pregnancies are another cause of either or both of the babies having respiratory distress.

What Are the Signs and Symptoms of Respiratory Distress in Neonates?

Usually, respiratory distress is easily noticeable at the time of birth and progresses with time. There are a few signs and symptoms that show the severity of the condition, such as:

  • Shallow breathing.

  • Rapid breathing.

  • Grunting sound during breathing.

  • The blue color change is seen on lips, fingers, and toes (cyanosis).

  • Chest retraction.

  • Nasal flaring.

  • Decreased urine output.

  • Apnea (brief stop of breathing movement).

How to Diagnose Respiratory Distress in Neonates?

There are many diagnostic options available to confirm the condition:

  • Physical Examination: Cyanosis of finger, ear or toes, or lips show respiratory distress due to lack of oxygen and breathing difficulties.

  • Blood Gas Analysis: Positive results show low oxygen and excess acid in the body fluid.

  • Chest X-Ray: The radiographic image is used to diagnose the condition. Usually, babies with the condition show a cloudy appearance of lungs on X-ray.

  • Lab Test Results: It is used to rule out any infection associated with the condition.

  • Pulse Oximetry Test: It is useful to measure blood oxygen level with a sensor attached to a baby’s fingertip, ear, or toe.

How to Manage Respiratory Distress in Neonates?

  • Management of this condition depends on the age and severity of it. The very first line of treatment is taking full genetic and family history to rule out risk factors and differential diagnoses. Secondly, the severity of distress is measured using lab reports, X-rays, and physical signs.

  • If the distress is severe, the baby shows the sign of grunting while breathing, flaring of nostrils, apnea, or cyanosis. In this case, immediate diagnostic measures are used, such as pulse oximetry and chest radiography, along with supplemental oxygen and resuscitation treatment. Physicians treating the baby should be familiar with updated guidelines and protocols for resuscitation, as it is usually the very first treatment option they go for. Supplemental oxygen is given using blow-by oxygen, nasal cannula, or ventilators. Also, antibiotics are administered to treat any secondary infection. In a fatal condition like pneumothorax, needle compression or chest tube drainage is done. Another option is the administration of synthetic surfactant directly into the newborn’s airway at 100mg per 1kg of the baby’s body weight. With some adverse effects, this treatment still shows promising results.

  • In mild distress cases, the newborn shows signs like mild tachypnea or grunting. Newborns are given moist oxygen treatment, kept in a warm environment, and observed for 10 to 20 minutes. Additionally, body fluid and electrolyte balance should be observed, and if it decreases intravenously, it should be externally given.


With certain risk factors and many etiological factors, respiratory syndrome is one of the most common conditions that bring newborns to the neonatal intensive care unit. However, if the condition is mild, it can be managed with proper care and observation; the severe condition also can be life-threatening.

Frequently Asked Questions


How Is Respiratory Distress Caused in Newborns?

Respiratory distress occurs when babies are born prematurely with underdeveloped lungs causing difficulty in breathing. An infant born earlier is more likely to have respiratory distress as it cannot breathe enough oxygen due to insufficient surfactant in the lung.


What Are the Different Phases of Respiratory Distress?

Respiratory distress undergoes three phases; exudative, proliferative, and fibrotic. The course of each phase differs, resulting in variable disease progression.
- Exudative Phase - The complex interplay of pro-inflammatory and anti-inflammatory causes damage to the alveolar epithelium and the vascular endothelium, producing leakage of water, protein, and red blood cells into the interstitium and alveolar lumen.
- Proliferative Phase - Type II cells proliferate with epithelial cell regeneration, fibroblastic reaction, and remodeling.
- Fibrotic Phase - In some patients, the condition may progress to an irreversible fibrotic phase involving collagen deposition in alveolar vascular beds.


What Is the Treatment of Respiratory Distress?

The first-line treatment of respiratory distress is assisted breathing or mechanical ventilation and fluid administration. In addition, high doses of Methylprednisolone may be used to reduce mortality and morbidity.


What Are the Early Signs of Respiratory Distress?

People with respiratory distress may have to work harder to breathe and show the following signs-
- Increased breathing rate.
- Bluish color changes to the skin, nails, and lips.
- Grunting.
- Nose flaring.
- Sweating.
- Wheezing.
- Retractions of the chest.


What Are the Benefits of Respiratory Care?

Respiratory care involves optimizing the respiratory function of the individual so that he can breathe easily and perform daily activities. In addition, respiratory therapy helps in faster healing and improved immune function by diagnosing, monitoring, and treating the condition in all age groups.


How to Manage Respiratory Distress in Newborns?

Majority of the newborns that are diagnosed with respiratory distress recover well. The treatment may include
- Nasal Continuous Positive Airway Pressure (nCPAP) - The device provides breathing support by pushing air through prongs in the nose.
- Mechanical Ventilation - A ventilator is life support for severe cases of respiratory distress syndrome.
- Surfactant Replacement Therapy - This is used in cases where the newborn continues to struggle to breathe despite the use of nCPAP.
- Fluid and Nutrition - These must be given to help prevent malnutrition. Nutrition plays a critical role in the development of the lungs.


What Is the Most Prevalent Respiratory Disease?

Some of the most common respiratory diseases are asthma, chronic obstructive pulmonary disease (COPD), occupational lung disease, and pulmonary hypertension. The other conditions may include lung cancer, pneumonia, pleural effusion, and emphysema.


What Is the Normal Breathing Pattern of Newborns?

Newborn babies have distinct breathing patterns. In the initial months of life, the baby can breathe only through his nose, which may cause sounds varying from snorts to grunts and gurgles to whistles during inhalation and exhalation.


Can Breathing of My Baby Be Monitored?

Newborns have irregular breathing with no pauses longer than ten seconds between each breath. Certain monitors can help track a baby's breathing, heart rate, oxygen saturation levels, and temperature. They can provide sleep analytics to study babies’ sleep patterns too.
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Dr. Sajeev Kumar
Dr. Sajeev Kumar



respiratory distress
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