Assessment Of Respiratory Distress In Newborns

When a newborn has trouble breathing, it’s a situation that demands immediate attention. This condition is known as respiratory distress¹ and can be quite serious. It affects the infant's ability to breathe properly and get enough oxygen into their bloodstream. In this article, we’ll break down what respiratory distress in newborns is, why it happens, and how it can be identified, treated and prevented. 

What is respiratory distress in newborns?

Imagine a baby’s first breath; it’s a pivotal moment that signifies the start of life outside the womb. However, for some infants, this moment is convoluted with challenges. Respiratory distress is one such challenge, marked by the baby's struggle to breathe. It's like watching someone trying to breathe through a narrow straw; no matter how hard they try; they just can’t seem to get enough air. This condition can be caused by several factors, such as infections, premature birth, or lung problems. The main issue is that the baby's lungs aren’t working efficiently, making it difficult to maintain the delicate balance of oxygen and carbon dioxide in their blood.

The clinical signs of trouble

The symptoms of respiratory distress in newborns are hard to miss. They include:²

• Tachypnoea (Rapid breathing):³ the first, and often most noticeable, sign of respiratory distress is rapid breathing. Newborns typically breathe about 40-60 times per minute. Rates higher than this can indicate that the baby is struggling to get enough oxygen
• Grunting: this is a sound made by the newborn that can be heard at the end of each breath. It's caused by the baby trying to keep air in the lungs to improve oxygen exchange
• Nasal flaring: widening of the nostrils during breathing is another sign that the infant is working harder to breathe
• Retractions: when the baby uses muscles between the ribs, below the rib cage, or in the neck to breathe, it's a sign that they are struggling. These muscles usually aren't visible, but in cases of distress, the skin pulls in around them
• Cyanosis: a bluish tint to the skin, especially around the lips and fingertips, indicating a lack of oxygen in the blood
• Apnoea Episodes: brief pauses in breathing can be a serious sign of respiratory distress or instability

Diagnosing the Issue

To understand what’s causing the baby’s distress, healthcare providers turn to several diagnostic tools. 

• Blood gas analysis: this test measures the levels of oxygen and carbon dioxide in the baby's blood. It can help determine how well the baby's lungs are functioning
• Chest x-ray: an X-ray of the chest can show if there's any fluid in the lungs, if the lungs are underdeveloped, or if there are any structural abnormalities causing the distress
• Lung ultrasound:⁴ a non-invasive method of visualising lung abnormalities, fluid accumulation, or other signs indicative of respiratory conditions
• Complete blood count (CBC):⁵ this common blood test can help identify infections or anaemia, which might contribute to respiratory problems
• C-reactive protein (CRP): elevated levels of CRP can indicate inflammation or infection in the body, including in the lungs
• Echocardiography: if a heart problem is suspected to be a cause of the breathing difficulty, an echocardiogram can help assess the heart's structure and function

Assessment tools and scoring systems

To systematically evaluate and quantify the severity of respiratory distress, healthcare providers utilise specific assessment tools:

• Silverman-anderson score:⁶ this scoring system evaluates five physical signs of respiratory distress (nasal flaring, intercostal retraction, xiphoid retraction, grunting, and chest movement), each scored from 0 to 2. A higher total score indicates more severe distress
• Downes score:⁷ like the Silverman-Anderson score, the Downes score assesses respiratory distress severity based on respiratory rate, retractions, air exchange, cyanosis, and supplemental oxygen need. This scoring helps in deciding the level of intervention required

The importance of diagnosis

The timely and accurate diagnosis of respiratory distress in newborns is paramount for several reasons. First, it enables healthcare providers to quickly identify the underlying cause of the distress, whether it’s due to infections, structural anomalies, or prematurity-related complications like respiratory distress syndrome (RDS). This early identification is crucial because the treatment approach varies significantly depending on the root cause. For instance, infections may require antibiotics, while RDS might be treated with surfactant therapy. 

Moreover, an early diagnosis can prevent the progression of the condition to more severe stages, potentially avoiding long-term complications or even life-threatening situations. It also allows for the immediate initiation of appropriate interventions, such as oxygen therapy or mechanical ventilation, to support the infant's breathing. In essence, the diagnosis of respiratory distress acts as the first critical step in a chain of decisions that optimise the newborn’s chances of full recovery and minimise the risk of adverse outcomes. Understanding the importance of diagnosis underscores not just the technical aspects of neonatal care, but also its profound impact on the lives of infants and their families.

The path to recovery

The journey to recovery for new-borns respiratory distress involves a tailored approach that considers the severity and underlying cause of their condition. Treatment strategies include:⁸

1. Oxygen therapy: for many infants, supplemental oxygen is the first line of treatment. Oxygen can be delivered through a nasal cannula (a small tube that fits under the baby's nose), or through more advanced methods like CPAP (Continuous Positive Airway Pressure) that help keep the lungs open and filled with air
2. Mechanical ventilation:⁹ in cases where a newborn is unable to breathe sufficiently on their own, mechanical ventilation may be required. This involves using a machine to assist or take over the work of breathing for the baby, ensuring they receive adequate oxygen while their lungs recover or mature
3. Surfactant therapy:⁵ for newborns with respiratory distress syndrome (RDS)– a common cause of respiratory distress in preterm infants – treatment may include the administration of surfactant. This substance helps reduce the surface tension within the lungs, making it easier for the baby to breathe
4. Infection management: if respiratory distress is caused by an infection, antibiotics or antiviral medications will be necessary. Treating the underlying infection can significantly improve breathing difficulties
5. Supportive care: alongside the mentioned treatments, supportive care plays a crucial role. This includes maintaining the baby’s body temperature, ensuring proper nutrition, and monitoring for any complications or additional health concerns

Overall, the treatment for respiratory distress depends on the underlying cause but aims to ensure the baby receives enough oxygen. In mild cases, supplemental oxygen, given through a small tube in the nose, might suffice. More severe cases may require mechanical ventilation to assist the baby’s breathing efforts. Medications to treat infections or to help the lungs function more effectively might also be necessary. The goal is to support the baby’s breathing until they are strong enough to breathe on their own.

Prevention and education 

Preventing respiratory distress in newborns is a multifaceted effort that encompasses both targeted prenatal care and broad public health initiatives. 

Administering corticosteroids to expecting mothers at risk of premature delivery is a critical strategy that can speed up lung maturation in the foetus, significantly reducing the risk of respiratory distress syndrome. Equally important is the avoidance of unnecessary early deliveries whenever possible, as allowing the foetus more time to develop in the uterus can decrease the incidence of respiratory problems post-birth. This approach is complemented by the effective management of maternal health conditions such as diabetes and hypertension, which if left uncontrolled, can elevate the risk of respiratory distress in newborns.

Beyond individual care, the education of expectant parents and caregivers about the signs of respiratory distress and the critical importance of prenatal care plays a vital role. Awareness and educational campaigns are essential for encouraging timely medical consultations for concerning symptoms, both before and after birth. Additionally, ensuring that healthcare professionals, particularly those specialising in neonatal care, receive training in the latest assessment and treatment protocols can markedly improve outcomes for newborns experiencing respiratory distress. Together, these strategies form a comprehensive approach to reducing the occurrence and impact of this condition and safeguarding the health of the youngest and most vulnerable patients.

FAQs

What causes respiratory distress in newborns?

Respiratory distress in newborns can arise from various factors such as infections, premature birth, or lung problems. These issues can make it hard for the baby to breathe effectively, and maintain the essential balance of oxygen and carbon dioxide in their blood.

How can I recognise if my newborn is experiencing respiratory distress?

Signs of respiratory distress in new-borns include rapid breathing (more than 60 breaths per minute), grunting sounds, flaring of the nostrils, visible retractions (using extra muscles to breathe), a bluish tint to the skin indicating low oxygen levels, and episodes of paused breathing (apnoea).

What diagnostic tests are used to identify the cause of a newborn’s respiratory distress?

Healthcare providers may use a variety of diagnostic tools, including blood gas analysis to measure oxygen and carbon dioxide levels, chest X-rays to look for fluid or abnormalities in the lungs, complete blood counts to identify infections or anaemia, C-reactive protein tests for inflammation or infection, and echocardiography if a heart problem is suspected.

What are the treatment options for respiratory distress in newborns?

Treatment depends on the underlying cause but generally includes oxygen therapy, mechanical ventilation for severe cases, surfactant therapy for Respiratory Distress Syndrome (RDS), infection management with antibiotics or antivirals, and supportive care focusing on maintaining the baby's body temperature, nutrition, and monitoring for complications.

How can respiratory distress in newborns be prevented?

Prevention efforts include administering corticosteroids to those who are pregnant and at risk of preterm delivery to speed up foetal lung maturation, avoiding unnecessary early deliveries, managing maternal health conditions like diabetes and hypertension, educating expectant parents about the signs of respiratory distress and the importance of prenatal care, and ensuring healthcare professionals are trained in the latest neonatal care protocols.

Summary

Respiratory distress in new-borns is a serious but manageable condition with timely intervention. Understanding its signs, causes, and treatments can demystify this medical challenge, offering hope and reassurance to concerned parents and caregivers. With the advances in neonatal care, the prospects for babies born with respiratory difficulties continue to improve, ensuring that they have the best possible start in life.