RESPIRATORY CONDITIONS · NEONATAL
The newborn with respiratory distress
At the bedside, many causes of respiratory distress look alike - the skill is knowing what's causing it. Here are the conditions you'll meet in the SCN and NICU: how to recognise, stabilise and tell them apart.
BROWSE THE CONDITIONS
Conditions in this section
The conditions you'll meet most in the nursery. New to respiratory distress? Start with the approach → (also in Foundations below).
Transient Tachypnoea of the Newborn
Delayed clearance of fetal lung fluid - usually 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.
Chronic Lung Disease (BPD)
Chronic lung disease of prematurity - arrested alveolar and vascular growth.
Congenital Lung Malformations
CPAM, sequestration and friends - sorted by airway connection and blood supply.
Pleural Effusions & Chylothorax
Transudate vs exudate, and the milky lymphocyte-rich tap of chylothorax.
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 | Ventilated, or infant with RDS/MAS | 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 |
FOUNDATIONS · GO DEEPER
Foundations & deep dives
The approach, plus the physiology and support underneath the conditions - useful for exam prep.
Approach to respiratory distress
Recognise it, stabilise the baby, and work through the differential - lungs, heart, sepsis or surgical. The starting point for every condition below.
Lung development & respiratory physiology
The five stages of lung development, surfactant and fetal lung fluid, and the physiology of the first breath - the foundation under every condition below.
Respiratory support & ventilation
CPAP and the escalation ladder, the conventional ventilator settings and what each does, surfactant delivery, HFOV and lung-protective targets.
Pulmonary surfactant
What it is, what it's made of, the proteins, how it's produced, Laplace's law, and exogenous surfactant preparations.
When to call NETS
Always check with your consultant before calling NETS. In a stabilise-and-transfer setting, call early once agreed and stabilise while you wait.
- Persistent or rising oxygen requirement / climbing FiO₂
- Need for CPAP or ventilation beyond local capability
- Surgical or complex problems needing a NICU (e.g. CDH) - PPHN and air leak can often be managed locally, so discuss first
- 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.