Respiratory distress in a newborn refers to a group of signs indicating that a baby is having difficulty breathing effectively, most often appearing within the first hours after birth.
Rather than a single condition, it is a pattern of physical findings that together suggest the lungs are not working as they should. This pattern typically includes breathing that is unusually fast, often exceeding roughly 60 breaths per minute, along with visible effort during breathing such as the chest pulling inward between or below the ribs with each breath, flaring of the nostrils, and a grunting sound made during exhalation as the baby instinctively tries to keep the lungs' small air sacs from collapsing. Because respiratory distress can range from mild and short-lived to severe and life-threatening, it is treated as a finding that always warrants prompt evaluation rather than something to observe and wait out at home.
Causes and Risk Factors of Respiratory Distress in Newborns
Respiratory distress syndrome, one of the most well-known causes, occurs when a baby's lungs lack sufficient surfactant, a substance that keeps the lungs' tiny air sacs open, and is most common in babies born before 34 weeks of pregnancy since surfactant production increases substantially in the final weeks before full term.
Transient tachypnea of the newborn is a generally milder and shorter-lived cause, resulting from a delay in clearing normal fluid from the lungs after birth, and tends to resolve within a day or two.
Other significant causes include meconium aspiration, in which a baby inhales meconium-stained fluid around the time of birth, pneumonia or infection affecting the lungs, and, less commonly, structural problems such as a diaphragmatic hernia or airway malformation.
Risk factors for respiratory distress include prematurity, delivery by cesarean section without labor, being born to a mother with diabetes, and being the second-born of a set of twins, though respiratory distress can occur in full-term babies without any of these risk factors present.
When to Seek Medical Care
Because respiratory distress in a newborn can progress quickly and, if untreated, can lead to dangerously low oxygen levels, any signs of labored or unusually fast breathing, grunting, nostril flaring, or visible chest retractions should be brought to the immediate attention of medical staff while still in the hospital, or should prompt urgent medical evaluation if noticed after a baby has gone home. Additional signs that should prompt the same level of urgency include a bluish tint to the lips or skin, unusual lethargy or difficulty waking, or pauses in breathing lasting several seconds. Because early treatment substantially improves outcomes for most causes of respiratory distress, these signs should never be watched at home in the hope that they will resolve on their own.