Respiratory, cardiac, and neurological causes of neonatal respiratory distress
THE CONTEXT
Gestation, delivery circumstances, timing, and accompanying clinical signs help identify the likely cause of neonatal respiratory distress.
Respiratory causes
•
Respiratory distress soon after birth in a preterm neonate is likely to reflect respiratory distress syndrome or delayed adaptation causing transient tachypnea.
•
Meconium aspiration syndrome is expected when a term neonate born through meconium-stained liquor develops respiratory distress soon after birth.
•
A term neonate developing respiratory distress soon after elective cesarean delivery is likely to have transient tachypnea of the newborn.
•
Suprasternal recessions, with or without stridor, indicate upper airway obstruction.
Cardiac causes
•
Respiratory distress accompanied by hepatomegaly or cyanosis may indicate heart disease.
•
Transposition of great vessels usually presents on the first day with progressive distress; most other cardiac conditions present after the first week.
•
A preterm neonate with a systolic murmur, tachypnea, and hepatomegaly is likely to have patent ductus arteriosus.
Neurological causes
•
Birth asphyxia, cerebral hemorrhage, and meningitis can cause tachypnea and respiratory distress.
•
Neonates with these neurological causes are usually lethargic and have poor neonatal reflexes.