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Pediatrics in Review is the official journal of the American Academy of Pediatrics.A monthly publication, it has been published continuously since 1979. Pediatrics in Review is owned, published, and trademarked by the American Academy of Pediatrics, 141 Northwest Point Boulevard, Elk Grove Village, Illinois, 60007. Copyright © 2010 by the American Academy of Pediatrics. All rights reserved. Print ISSN: 0191-9601. Online ISSN: 1526-3347.
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Article fetus and newborn
Newborn Respiratory Disorders
Jamie B. Warren, MD,* JoDee M. Anderson, MD, MEd*
After completing this article, readers should be able to:
Author Disclosure Drs Warren and Anderson have disclosed no ﬁnancial relationships relevant to this article. This commentary does notcontain a discussion of an unapproved/ investigative use of a commercial product/ device.
1. Evaluate and diagnose the most common causes of respiratory distress in the newborn period. 2. Differentiate between the normal results of a newborn chest radiograph and the radiographic patterns that reﬂect neonatal respiratory distress syndrome, meconium aspiration syndrome, retained fetal lung liquidsyndrome, and neonatal pneumonia. 3. Recognize subglottic stenosis as a complication of endotracheal intubation. 4. Distinguish between pulmonary disease and cyanotic congenital heart disease as a cause of hypoxemia and acidosis in the neonate. 5. Discuss common complications of various respiratory disorders (such as meconium aspiration syndrome) and the untoward effects of speciﬁc therapies(intubation and mechanical ventilation). 6. Describe how chronic lung disease may result from meconium aspiration.
Neonatal respiratory disorders account for most admissions to intensive care units in the immediate newborn period. Newborns in respiratory distress must be evaluated promptly and accurately; occasionally, neonatal respiratory distress is life-threatening and requiresimmediate intervention. The causes of respiratory distress in the newborn are numerous and are due to pulmonary or nonpulmonary processes. (1) Initial stabilization of the neonate, through management of the airway, breathing, and circulation, takes precedence over determining the cause. A thorough initial assessment, including maternal and neonatal history, physical examination, and appropriate use ofdiagnostic tests, is essential to diagnosing the cause of respiratory distress.
ABG: BPD: CBC: CLD: CPAP: ECMO: FiO2: GBS: iNO: MAS: NRP: PaCO2: PaO2: RDS: RFLLS: arterial blood gas bronchopulmonary dysplasia complete blood count chronic lung disease continuous positive airway pressure extracorporeal membrane oxygenation fraction of inspired oxygen group B Streptococcusinhaled nitric oxide meconium aspiration syndrome Neonatal Resuscitation Program partial pressure of arterial carbon dioxide partial pressure of arterial oxygen respiratory distress syndrome retained fetal lung liquid syndrome
Respiratory distress in the neonate most commonly presents as one or all of the following physical signs: tachypnea, grunting, nasal ﬂaring, retractions, and cyanosis.(2) A normal respiratory rate in a newborn is between 30 and 60 breaths/min; tachypnea is classiﬁed as respiratory rates greater than 60 breaths/ min. Patients born with surfactant deﬁciency and poorly compliant lungs have rapid, shallow breathing. Infants experiencing increased airway resistance, such as those who have subglottic stenosis, usually exhibit slower deep breathing (hyperpnea)....