Prematurity is the single most common factor in respiratory distress or cyanosis of the neonate and occurs most frequently in infants < 1200 grams and 30 weeks of gestation. Premature infants have an immature central respiratory control center and are easily affected by environmental or metabolic changes.

Risk of neonatal respiratory distress or cyanosis is increased during multiple gestations and prenatal maternal complications, only because the risk of pre-term delivery increases with these conditions.

Anatomy and Physiology Review: See A and P, fetal vs neonatal circulation, closure of the ductus arteriosus and ductal dependent lesions.

Neonatal respiratory distress or cyanosis can also be caused by lung or heart disease,

• primary pulmonary hypertension,
• CNS disorders,
• mucus obstruction of nasal passages,
• spontaneous pneumothorax,
• meconium aspiration,
• amniotic fluid aspiration,
• lung immaturity,
• pneumonia,
• shock and sepsis,
• metabolic acidosis,
• diaphragmatic hernia, and
• tracheoesophageal fistula.

Neonatal respiratory distress or cyanosis can lead to

• cardiac arrest,
• permanent neurological damage, or
• death.

Assessment

Assessment findings during neonatal respiratory distress or cyanosis include

• tachypnea,
• paradoxical breathing,
• intercostal retractions,
• nasal flaring,
• expiratory grunting, and
• choking, gagging, or cyanosis with feeding.

Management

Management considerations of neonatal respiratory distress or cyanosis include

• support the ABC’s with adequate oxygenation and
• maintenance of patent airway; as well as the
• initiation of chest compressions with indicated.

Pharmacological interventions include oxygen and cardiac medications when indicated.