Causes of Respiratory Distress in the Neonate

Differential Diagnosis

Obstruction

• Congenital Anomalies:  Choanal atresia, laryngeal web, laryngeal malacia, tracheal aplasia, tracheal stenosis, tracheoesophageal fistula.
• External Compression:  Vascular rings, tumors, cysts.
• Trauma:  Post-extubation laryngeal edema, atelectasis, subglottic stenosis, vocal cord, paralysis, laryngeal fracture, tracheal perforation

Parenchymal Disease

• Congenital Anomalies:  Cysts, congenital cystic adenomatous malformation, hypoplasia, agenesis, lobar emphysema, chylothorax, congenital pulmonary lymphangiectasia
• Acquired disorders:  Transient tachypnea of the newborn (retained fetal fluid, delayed transition), respiratory distress syndrome, meconium aspiration syndrome, pneumonia, BPD, pulmonary hemorrhage, pneumothorax, pneumomediastinum

Non-pulmonary Causes:

Heart disease, intracranial causes, salicylism, metabolic acidosis

Miscellaneous Causes:

Congenital diaphragmatic hernia, phrenic nerve paralysis, muscular diseases and weakness, chest wall deformity, sepsis, asphyxia

Treatment

Treatment depends on the underlying etiology.  The most common cause of respiratory distress in the premature infant is surfactant deficiency (see RDS), but sepsis and pneumonia must be treated until ruled out.

Meconium Stained Infants

Airway management takes priority over all neonatal resuscitation protocol steps (prior to stimulation)
• oropharyngeal suction on the perineum with delivery of the head
• suction of oropharynx
• intubation and tracheal suction with ET tube and adapter
• repeat PRN
• resume resuscitation protocol