RESPIRATORY CONDITIONS · NEONATAL
The newborn in respiratory distress
Almost every breathless baby looks the same at the bedside. The skill isn't spotting distress - it's knowing what's causing it. This section walks through the conditions a registrar meets in the SCN and NICU: how to recognise, stabilise, and tell them apart.
START HERE
The first few minutes
Recognise
Spot the signs and quantify them - respiratory rate, work of breathing, SpO₂.
Support
Position, oxygen to target, early CPAP, thermoregulate, minimal handling.
Investigate
Pre/post-ductal sats, ABG, CXR, glucose and a sepsis screen.
Differentiate
Use gestation, onset, risk factors and the CXR to narrow the cause.
Escalate
Cover for sepsis, and call NETS early if support is rising or the baby is unstable.
BROWSE THE CONDITIONS
Conditions in this section
Transient Tachypnoea of the Newborn
Delayed clearance of fetal lung fluid - benign and self-limiting.
Respiratory Distress Syndrome
Surfactant deficiency in the preterm lung - atelectasis and poor compliance.
Meconium Aspiration Syndrome
Aspiration of meconium-stained liquor with airway obstruction and PPHN risk.
Persistent Pulmonary Hypertension
Failure of the normal fall in pulmonary vascular resistance - right-to-left shunt.
Pneumothorax & Air Leak
Extra-alveolar air - sudden deterioration, often in ventilated or MAS/RDS lungs.
Congenital Pneumonia
Early-onset infection (often GBS) that mimics RDS - always on the differential.
Congenital Diaphragmatic Hernia
Abdominal viscera in the chest with lung hypoplasia - often diagnosed antenatally.
Apnoea of Prematurity
Immature respiratory control - pauses with bradycardia/desaturation; a diagnosis of exclusion.
CLINICAL REASONING
Telling them apart at a glance
| Condition | Typical gestation | Onset | Classic CXR | Discriminating clue |
|---|---|---|---|---|
| TTN | Term / late-preterm (esp. elective CS) | First hours, resolves <72h | Hyperinflation, perihilar streaking, fluid in fissures | Benign & self-limiting; retained lung fluid |
| RDS | Preterm (esp. <34w) | Birth-hours | Diffuse ground-glass, air bronchograms, low volumes | Prematurity; improves with surfactant |
| MAS | Term / post-term | From birth | Patchy asymmetric infiltrates, hyperinflation ± air leak | Meconium-stained liquor; PPHN risk |
| PPHN | Term / post-term | Hours | Often clear or shows underlying cause; echo is diagnostic | Labile hypoxaemia; pre/post-ductal SpO₂ gap >10% |
| Pneumothorax | Any (ventilated, MAS, RDS) | Sudden | Hyperlucency, lung edge, mediastinal shift; transilluminates | Sudden desaturation, asymmetric chest |
| Pneumonia | Any | Birth-48h | Variable - can mimic RDS or be patchy | Sepsis risk factors; cover with antibiotics |
| CDH | Term (often antenatal dx) | From birth | Bowel loops in thorax, mediastinal shift | Scaphoid abdomen; avoid bag-mask ventilation |
| Apnoea of prematurity | Preterm | After first 24h (days 2-7) | Normal (diagnosis of exclusion) | Pauses >20s ± brady/desat; responds to caffeine |
When to call NETS
In a stabilise-and-transfer setting, call early - stabilise while you wait.
- Persistent or rising oxygen requirement / climbing FiO₂
- Need for CPAP or ventilation beyond local capability
- Suspected PPHN, CDH or significant air leak
- Any instability, or a baby not following the expected course
Take-home message: Neonatal respiratory distress is a final common pathway, not a diagnosis. Recognise and support first, then let gestation, timing, risk factors and the chest film point you to the cause - and treat sepsis and call for help while you work it out.
For registrar education. Saturation targets, support thresholds and referral criteria vary between units - always align to current ANZCOR and your local NICU/NETS protocols.