Respiratory problems are the most common cause of morbidity and mortality in newborns. Problems can occur in both term and premature infants and may be caused by infection, aspiration, lung immaturity, transient tachypnea of the newborn, pneumothorax, central nervous system disorders, cardiovascular issues, or apnea of prematurity. Common signs of respiratory distress include increased work of breathing, nasal flaring, grunting, wheezing, or cyanosis. Diagnosis involves examination, tests such as chest x-rays, and assessing for various causes of respiratory distress in the newborn. Treatment depends on the specific condition but may include oxygen, antibiotics, ventilation support, or drainage of pneumothoraces.

1. Discussion
Respiratory conditions of hish risk
newborn

2. Respiratory problems are the most common
cause of morbidity and mortality in the
neonatal period. Problems can occur in term
as well as in premature infants. The
midwifery; in managing labor and giving
direct care to the newborn baby ,is able to
recognize the first signs of respiratoy
distress.

3. Clinical signs of respiratory
problems .
▪ Increase work of breathing causing
▪ Recession of intercostals subcostal muscles ad
retraction of the sternum: the chest

4. Type Definition Causes
Stertor
Sonorous snoring sound,
mid-pitched,
monophonic, may
transmit throughout
airways, heard loudest
with stethoscope near
mouth and nose
Nasopharyngeal
obstruction—nasal or
airway secretions,
congestion, choanal
stenosis, enlarged or
redundant upper
airway tissue or
tongue

5. Stridor
Musical, monophonic,
audible breath sound.
Typically high-pitched.
Types: Inspiratory (above
the vocal cords), biphasic (at
the glottis or subglottis), or
expiratory (lower trachea)
Laryngeal obstruction—
laryngomalacia, vocal
cord paralysis, subglottic
stenosis, vascular ring,
papillomatosis, foreign
body

6. Wheezing
High-pitched, whistling sound,
typically expiratory,
polyphonic, loudest in chest
Lower airway obstruction—
MAS, bronchiolitis,
pneumonia
Grunting
Low- or mid-pitched,
expiratory sound caused by
sudden closure of the glottis
during expiration in an attempt
to maintain FRC
Compensatory symptom for
poor pulmonary
compliance—TTN, RDS,
pneumonia, atelectasis,
congenital lung malformation
or hypoplasia, pleural
effusion, pneumothorax

7. Causes of repiratory problem
▪ Infection
▪ Aspiration
▪ Lung immaturity
▪ Transient tachypnea of the newborn
▪ Pneumothorax
▪ Central nervous system disorders
▪ Cardiovascular and circulatory problems
▪ Apnea of prematurity

8. Infection :General infection
▪ A baby having generalized infection may present with sign of
respiratory distress .
▪ Baby may have respiratory rate greater than 60 breaths per
min
▪ Pale or cyanosed because of hypoxia

9. Congenital or acquired pneumonia
▪ A baby may be born with pneumonia that will
present soon after birth
▪ Pneumonia is the most common invasive bacterial
infection after primary sepsis. Early-onset
pneumonia is part of generalized sepsis that first
manifests at or within hours of birth ( see Neonatal
Sepsis).

10. ▪ Late-onset pneumonia usually occurs after 7 days
of age, most commonly in neonatal intensive care
units among infants who require prolonged
endotracheal intubation because of lung disease
(called ventilator-associated pneumonia).

11. Etiology of Neonatal
Pneumonia
Organisms are acquired from the maternal
genital tract or the nursery. These organisms
include :
▪ gram-positive cocci (eg, groups A and B
streptococci, both methicillin-sensitive and
methicillin-resistant Staphylococcus aureus)

12. ▪ gram-negative bacilli (eg, Escherichia
coli, Klebsiella species, Proteus species).
▪ In infants who have received broad-spectrum antibiotics,
many other pathogens may be found,
including Pseudomonas, Citrobacter, Bacillus, and Serratia.
Viruses or fungi cause some cases.

13. Risk factors
▪ The maternal risk factors associated with the
perinatal phase includes the premature onset of
labour under 37 weeks of gestation
▪ prolonged or premature rupture of membranes ie
if the membranes have been ruptured for longer
than 24 hours

14. ▪ maternal fever
▪ maternal chorioamnionitis.
▪ A complication during the labour or delivery
process can increase the risk for an infant to have
respiratory distress or conditions that mimic
congenital pneumonia.

15. Symptoms and Signs of
Neonatal Pneumonia
▪ Late-onset hospital-acquired pneumonia manifests with
unexplained worsening of the patient's respiratory status
and increased quantities and a change in the quality of the
respiratory secretions (eg, thick and brown). Infants may be
acutely ill, with temperature instability and neutropenia.

16. Diagnosis of Neonatal
Pneumonia
▪ Chest x-ray
▪ Evaluation includes chest x-ray, pulse oximetry,
blood cultures, and Gram stain and culture of
tracheal aspirate.

17. Treatment
▪ Usually vancomycin and a broad-spectrum beta-
lactam drug

18. Aspiration
Meconium aspirsation
Meconium is the first feces, or stool, of the newborn.
Meconium aspiration syndrome occurs when a newborn
breathes a mixture of meconium and amniotic fluid into the
lungs around the time of delivery.

19. ▪ Meconium aspiration syndrome, a leading cause of severe
illness and death in the newborn, occurs in about 5 percent
to 10 percent of births. It typically occurs when the fetus is
stressed during labor, especially when the infant is past its
due date.

20. Cinical presentation
▪ Bluish skin color in the infant
▪ Breathing problems
▪ Dark, greenish staining or streaking of the
amniotic fluid or the obvious presence of
meconium in the amniotic fluid
▪ Limpness in infant at birth

21. Diagnosis
▪ Before birth, the fetal monitor may show a slow heart
rate.
▪ At birth, meconium can be seen in the amniotic fluid. The
most accurate test to check for possible meconium
aspiration involves looking for meconium staining on the
vocal cords with a laryngoscope.

22. ▪ Abnormal breath sounds, especially coarse, crackly
sounds, are heard through a stethoscope.
▪ A blood gas analysis shows low blood acidity,
decreased oxygen and increased carbon dioxide.
▪ A chest X-ray may show patchy or streaky areas on
the lungs.

23. Treatment
▪ The newborn's mouth should be suctioned as soon
as the head can be seen during delivery. Further
treatment is necessary if there is thick meconium
staining and fetal distress. The infant may be
placed in the special care nursery or newborn
intensive care unit.

24. Other treatments may include:
▪ Antibiotics to treat infection
▪ Breathing machine to keep the lungs inflated
▪ Use of a warmer to maintain body temperature
▪ Tapping on the chest to loosen secretions

25. ▪ If there have been no signs of fetal distress during
pregnancy and the baby is a vigorous full-term
newborn, experts recommend against deep
suctioning of the windpipe for fear of causing a
certain type of pneumonia.

26. Other aspiration problems
▪ The baby inhales maternal blood or amniotic fluid
at delivery which can results in similar problems as
meconium aspiration .

27. ▪ Inaddition a baby may inhale milk reulting in
aspiration pneumonia. This may occur because of
vomiting or when there is fistula between the
airway and the esophagus

28. Lung immaturity
▪ Newborn respiratory distress syndrome (NRDS):
Happens when a baby's lungs are not fully developed
and cannot provide enough oxygen, causing breathing
difficulties. It usually affects premature babies.
It's also known as infant respiratory distress syndrome,
hyaline membrane disease or surfactant deficiency lung
disease.

29. ▪ NRDS usually occurs when the baby's lungs have
not produced enough surfactant.
▪ This substance, made up of proteins and fats, helps
keep the lungs inflated and prevents them
collapsing.
▪ A baby normally begins producing surfactant
sometime between weeks 24 and 28 of pregnancy.
▪ Most babies produce enough to breathe normally
by week 34.

30. ▪ If the baby is born prematurely, they may not have
enough surfactant in their lung
▪ Around half of all babies born between 28 and 32
weeks of pregnancy develop NRDS.
▪ In recent years the number of premature babies
born with NRDS has been reduced with the use of
steroid injections, which can be given to mothers
during premature labour.

31. ▪ The symptoms of NRDS are often noticeable
immediately after birth and get worse over the
following few days.
▪ They can include:
▪ blue-coloured lips, fingers and toes
▪ rapid, shallow breathing
▪ flaring nostrils
▪ a grunting sound when breathing

32. ▪ A number of tests can be used to diagnose NRDS and
rule out other possible causes.
▪ These include:
▪ a physical examination
▪ blood tests to measure the amount of oxygen in the
baby's blood and check for an infection
▪ a pulse oximetry test to measure how much oxygen is
in the baby's blood using a sensor attached to their
fingertip, ear or toe
▪ a chest X-ray to look for the distinctive cloudy
appearance of the

33. ▪ A number of tests can be used to diagnose NRDS and
rule out other possible causes.
▪ These include:
▪ a physical examination
▪ blood tests to measure the amount of oxygen in the
baby's blood and check for an infection
▪ a pulse oximetry test to measure how much oxygen is
in the baby's blood using a sensor attached to their
fingertip, ear or toe
▪ a chest X-ray to look for the distinctive cloudy
appearance of the

34. Transient tachypnea of the
newborn
▪ Transient tachypnea of the newborn, or TTN, is a
respiratory disorder usually seen shortly after
delivery in babies who are born near or at term.
Transient means it is short lived (usually less than
24 hours) and tachypnea means rapid breathing.

35. ▪ Transient tachypnea occurs mostly in term infants,
although it can affect the preterm group as well. It
is caused by the delayed clearing of lung fluid after
birth. It is more common in babies born by
cesarean section .

36. Causes
Maternal risk factors include :
▪ Delivery before completion of 39 weeks gestation
▪ A cesarean section without labor
▪ Gestational diabetes and
▪ Maternal asthma.

37. Fetal risk factors include:
▪ Male gender
▪ Perinatal asphyxia,
▪ Prematurity
▪ Small for gestational age and
▪ Llarge for gestational age infants.

38. Symptoms
Newborns with TTN have respiratory problems soon after birth
(within one to two hours).These usually consist of;
▪ some combination of rapid, noisy breathing (grunting)
▪ use of extra muscles to breathe (flaring nostrils or movements
between the ribs or breastbone known as retractions).

39. ▪ Baby may also be cyanosed.
▪ Tachypnea will be present ( sometimes the
respiratory rate will be over 100 breaths per
minutes.

40. Diagnosis
▪ The mother’s pregnancy and labor history are important to make the
diagnosis.
▪ A chest X-ray may be taken to eliminate other causes of respiratory
problems.
▪ A blood count and blood culture may be drawn to try to rule out
infection.
▪ TTN is usually diagnosed after monitoring the baby for one to two
days.

41. Treatment
▪ Oxygen
▪ Recovery usually occurs within 2 to 3 days.
▪ Treatment of transient tachypnea of the newborn is
supportive and involves giving oxygen and monitoring
arterial blood gases or pulse oximetry.

42. ▪ Less frequently, infants with transient tachypnea of the
newborn (TTN) may require continuous positive airway
pressure (CPAP) and occasionally even mechanical
ventilation.
▪ A small number of infants with TTN may develop persistent
pulmonary hypertension or pneumothorax.

43. Pneumothorax
▪ Pneumothorax is the collection of air or gas in the
space inside the chest around the lungs. This leads
to lung collapse.
▪ It may occur spontaneously after delivery or may
result from overvigorous bag and mask ventilation.

44. Causes
▪ A pneumothorax occurs when some of the tiny air sacs
(alveoli) in a baby's lung become overinflated and burst.
This causes air to leak into the space between the lung
and chest wall (pleural space).
▪ The most common cause of pneumothorax
is respiratory distress syndrome. This is a condition that
occurs in babies who are born too early (premature).

45. ▪ The baby's lungs lack the slippery substance
(surfactant) that helps them stay open (inflated).
Therefore, the tiny air sacs are not able to expand as
easily.
▪ If the baby needs a breathing machine (mechanical
ventilator), extra pressure on the baby's lungs, from the
machine can sometimes burst the air sacs.

46. ▪ Meconium aspiration syndrome is another cause of
pneumothorax in newborns.
▪ Before or during birth, the baby may breathe in the
first bowel movement, called meconium. This may
obstruct the airways and cause breathing
problems.

47. ▪ Other causes include pneumonia (infection of the lung)
or underdeveloped lung tissue.
▪ Less commonly, otherwise healthy infants can develop
an air leak when they take the first few breaths after
birth. This occurs because of the pressure needed to
expand the lungs for the first time. There may be
genetic factors which contribute to this problem.

48. Cinical features
▪ Pallor or cyanosis
▪ Difficulty in breathing
▪ An asymmetrical apperance to the chest
▪ The abdmen may appear distended as the
pneumothorax can push the disphragm down
▪ The breath sounds will not be equal on auscultation.

49. Diagnosis
▪ Chest x ray

50. Treatment
▪ Pneumothorax to be drained with the chest drain
may require
▪ If the pneumothorax is not sever , and the baby is
noth distressed the baby may be treated with
oxygen therapy and intravenous fluids until the air
from the pneumothorax is reabsorbed.

51. Congenital problems
▪ Sever congenita problems can cause respiratory
difficulties. These may involve mechanical
obstruction of the respiratory tract, and an
abnormality of development in chest and its
structures.

52. Upper airway problems
▪ Choanal atreisia : nasal obstruction allowing the baby to
breath only through the mouth
▪ Cleft palate ,which allows the tongue to fall to the back
of the pharynx causing obstruction
▪ Laryngeal obstruction: presence of cysts or
laryngomalacia whne the baby has a floppy larynx
causing laryngeal strider.

53. Lower airway problems
▪ Tracheoesophageal fistula, providing an abnormal passage
between the trachea and esophagus
▪ Hypoplastic lung : lung tissue that has not developed
adwequately
▪ Diaphragmatic hernia, where the gut herniates up into the
chest cavity through a defeat in the diaphragm

54. Central nervous system
disorders
▪ The newborn may show signs of respiratory ditress with
problems affecting the central nervous system ,
▪ The most common among them is hypoglycemia. It
results in deprivation of energy to brain tissue, which can
cause convulsion

55. ▪ Apnea may be the outward sign of convlsion in the
neonate, as his neurological system is immature.
▪ Intracranial hemorrhage may also result in signs of
respiratory distress. This is most common after perinatal
asphxia

56. Cardiovascular and
circulatory problems
▪ Because of the changes in circulation at birth, certain
cardiovascular problems will present with some respiratory
signs in the neonatal periods. Among the problems
presenting at birth are those, which involves failure of the
fetal circulation to change fully to the postnatal pattern and
congenital malformation of the heart and major blood
vessels .

57. Apnea and prematurity
▪ Apnea is a common problem found in babies of
less than 34 weeks gestation. It occurs because of
immaturity of the respiratory center in the brain
and respiratory fatigue.
▪ Apnea of prematurity occurs when newborns,
especially those born prematurely, stop breathing
for short periods of time. Apnea can be caused by
immaturity of the brain and weakness of the
muscles that keep the airway open.

58. Symptoms
▪ Very shallow breathing.
▪ The baby may also experience a drop in the heart
rate, known as bradycardia.
▪ The baby may or may not have associated poor
color and an appearance of not looking well.

59. Diagnosis
▪ Because most preterm babies have some degree
of apnea, they are usually kept on monitors that
measure heart rate and breathing rate.
▪ Alarms are set to notify the staff when lower heart
rate or breathing rate limits are met.

60. Mamagement
▪ Cardiorespiratory monitoring and use of
therapeutic respiratory stimulation helps to
prevent prolonged apnea .

61. ▪ Physical stimulation of the baby ,when he is
apneic, may be sufficient stimulus to remind him
to breath
▪ Alternatively if he does not breath respond to
tactile stimulation ,a bag and mask without oxygen
may be used to ventilate him until he breathe
spontaneously.

62. ▪ Babies who appear well but with multiple spells may be
placed on a caffeine preparation to help stimulate their
breathing.
▪ Proper positioning,
▪ slower feeding time,
▪ oxygen and in some cases ventilator support may be needed
to assist in breathing.

63. Principles of caring for a baby
with respiratory problems
▪ Positioning
▪ Observation
▪ Oxygenation
▪ Nutrition and hydration
▪ Basic physical care needs
▪ Meeting the emotional and psychological needs of
the baby and family .

64. Thank you