What is the probable cause of respiratory difficulty in the first few hours of an infants life?

Introduction[edit | edit source]

One of the most common reasons an infant is admitted to the neonatal intensive care unit is due to Respiratory distress[1]. Respiratory distress can be recognised as one or more signs of increased work of breathing which will be discussed below.

Signs and Symptoms[edit | edit source]

Below are the more common signs and symptoms and their causes:[2][3]

  • Weak cry
    • sign of fatigue and shows the child is prioritising energy expenditure for work of breathing.
  • Grunting
    • Increase positive end expiatory pressure (PEEP) by closing of the glottis (therefore increasing Functional Residual Capacity (FRC).

  • Tachypnoea
    • Unable to increase Tidal volume and therefore increase Respiratory rate.
  • Cricoid Tug/Tracheal tug
    • Increase pull of diaphragm is transmitted as a downwards tug on the trachea during inspiration.

  • Sternal recession
    • Due to high negative pressures on inspiration.
  • Sub-costal and intercostal recession
    • Due to high negative pressures on inspiration.

  • Nasal flaring
    • To help increase the diameter of the airway.
  • Head bopping
    • Due to high use of sternocleidomastoid and scalene muscles.

  • Clammy
    • Due to high energy expenditure to breathe therefore sweating to regulate temperature.
  • Pallor
    • Not oxygenating effectively.
  • Cyanosis
    • Dependent on haemoglobin and peripheral circulation-indicates poor oxygen saturation levels.
  • Stridor
    • Partial obstruction of upper trachea.

  • Wheeze
    • Narrowing or obstruction of the small airways by secretions or inflammation.
  • Lethargy
    • Being breathless and working hard causes discomfort and agitation. Also reserved energy fro work of breathing.
  • Tachycardia
    • to assist in oxygen transport.
  • Hypoxemia
    • reduced ability to oxygenate.
  • Hypercarbia
    • reduced ability to expire carbon dioxide.

How can Physiotherapy help?[edit | edit source]

The goals of physiotherapy is to help increase tidal volumes, help clear secretions, help improve oxygenation around the body and manage ventilation.[1]

  • Manual techniques such as vibrations and percussion
  • Postural drainage
  • Saline and Suctioning (saline helps clear secretions)
  • Therapeutic exercise
  • Central Lavage
  • Bronchoalveolar lavage (BAL)
  • Use of various types of equipment to assist in respiratory care e.g. Acapella / PEP mask / Cough Assist devices.
  • Education and advice on self management.

References[edit | edit source]

  1. ↑ 1.0 1.1 Reuter S, Moser C, Baack M. Respiratory distress in the newborn. Pediatrics in review. 2014 Oct;35(10):417.
  2. Taussig LM, Landau LI. Pediatric respiratory medicine. Elsevier Health Sciences; 2008.
  3. Edwards MO, Kotecha SJ, Kotecha S. Respiratory distress of the term newborn infant. Paediatr Respir Rev. 2013 Mar; 14(1):29-36; quiz 36-7.

What are infant breathing disorders?

The lungs are some of the last organs to develop in your baby’s body during the prenatal stage. Some important parts of their lungs don’t develop until the end of pregnancy.

Surfactant is a substance that helps reduce surface tension in their lungs. It doesn’t develop until the eighth or ninth month of pregnancy. If your baby is born prematurely, their lungs may not have time to develop fully. This can lead to a variety of breathing disorders.

If your baby has a breathing disorder, they may develop symptoms immediately after they’re born or days later. The symptoms can include:

  • the absence of breathing
  • shallow breathing
  • irregular breathing
  • rapid breathing
  • grunting
  • nasal flaring
  • retractions, which happen when your baby pulls their chest or abdominal muscles in with each breath

Prematurity is the main cause of breathing disorders related to lung development. If your baby’s lungs aren’t fully developed by the time they’re born, they may have problems breathing.

Congenital defects that affect their lung or airway development can also lead to breathing problems.

Many types of breathing disorders related to lung development exist. They usually occur when a baby is born, before their lungs have time to develop completely. The following types of breathing disorders can occur:

Pneumonia

If your baby is born prematurely, and their lungs aren’t fully developed, they have an increased risk of getting pneumonia.

Premature babies have less developed immune systems and are therefore more susceptible to infections. They also may be on ventilators and spend time in the NICU which increase the risk of infection.

Meconium aspiration

Meconium is the earliest stool that your infant produces, sometimes in the womb. It’s possible for them to inhale meconium shortly after birth. This is called “aspiration.” This can cause an infection in their lungs or lung inflammation.

Pneumonia can occur due to an infection or meconium aspiration. Meconium aspiration is more common in full-term or post-term babies, rather than premature babies.

Respiratory distress syndrome

If your baby was born prematurely, their ability to make surfactant might not be fully developed. This can cause the small sacs in their lungs to collapse, making it difficult for them to breathe. This condition is called respiratory distress syndrome. It’s most common in newborns, especially those born six weeks prematurely or more.

Bronchopulmonary dysplasia

Babies born more than 10 weeks early are at the greatest risk of bronchopulmonary dysplasia. This condition can occur due to therapy your baby may receive if they have premature lung development.

If your baby is born this early, they may need to receive oxygen and breathing help from a mechanical ventilator. This treatment is lifesaving. However, it can also scar your baby’s fragile lungs. This can make it even harder for them to breathe.

Your baby is at higher risk of breathing disorders if they’re born before their lungs have time to mature fully. The earlier your baby is born, the greater their risk of breathing problems.

Your baby’s doctor may diagnose them with a breathing disorder, based on observable signs and symptoms. Several diagnostic tests can also help them learn if your baby has a breathing disorder. For example, they may order:

  • an X-ray of your baby’s lungs
  • pulse oximetry to measure the oxygen levels in your baby’s blood
  • an arterial blood gas test to measure the levels of oxygen and carbon dioxide in your baby’s blood, as well as the acidity of their blood

Your baby’s treatment plan will depend on their specific condition and the severity of their symptoms. Their doctor may prescribe medications, oxygen therapy, or mechanical ventilation.

Medications

Medications for infant breathing disorders include the following:

  • Respiratory medications, such as bronchodilators, may help open up your baby’s airways to make breathing easier.
  • Artificial surfactant can prevent the small air sacs in their lungs from collapsing.
  • Diuretics can get rid of the excess fluid in their lungs.
  • Caffeine is a common treatment for recurring apnea in babies born prematurely.

Oxygen therapy

Breathing problems may stop your baby from getting enough oxygen into their lungs. They may need oxygen therapy.

Mechanical ventilation

If your baby can’t breathe on their own due to lung problems, they may need help from a machine known as a ventilator.

If your baby’s breathing problems are due to a congenital defect, they may need surgery to correct the problem. Your baby’s doctor may also recommend home care, which may involve continued oxygen administration and respiratory therapy.

Your baby’s outlook will depend on several factors, such as:

  • their gestational age
  • the type of breathing disorder they have
  • the severity of their symptoms

If your baby’s doctor diagnoses them with a breathing problem, ask them for more information about their specific condition, treatment options, and outlook.

It’s not always possible to prevent your baby from developing breathing disorders. Avoiding premature delivery will lower their risk of developing breathing problems.

If you’re pregnant, you can reduce your risk of premature delivery by following these tips for a healthy pregnancy:

  • Talk to your doctor early to make sure you get good prenatal care.
  • Eat a healthy diet.
  • Avoid tobacco.
  • Avoid cocaine use.
  • Avoid alcohol.

What is the most likely cause of this infants respiratory distress?

The most common etiology of neonatal respiratory distress is transient tachypnea of the newborn; this is triggered by excessive lung fluid, and symptoms usually resolve spontaneously. Respiratory distress syndrome can occur in premature infants as a result of surfactant deficiency and underdeveloped lung anatomy.

What causes difficulty in breathing in infants?

Prematurity is the main cause of breathing disorders related to lung development. If your baby's lungs aren't fully developed by the time they're born, they may have problems breathing. Congenital defects that affect their lung or airway development can also lead to breathing problems.

What is probably the most common respiratory disorder in newborns?

Epidemiology and risk factors. Transient tachypnoea of the newborn (TTN) is the most commonly diagnosed respiratory condition in term newborn infants [8].

Why is the first breath of air is so difficult for a neonate to take?

At birth, the baby's lungs are filled with fluid. They are not inflated. The baby takes the first breath within about 10 seconds after delivery. This breath sounds like a gasp, as the newborn's central nervous system reacts to the sudden change in temperature and environment.