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Newborn respiratory distress occurs in about 7% of deliveries.1 Respiratory distress syndrome, which occurs primarily in premature infants, affects about 1% of newborns, resulting in about 860 deaths per year.2 With increased survival of preterm and late preterm infants, management of respiratory distress in newborns has become challenging.3,4 Because early recognition improves the care of these newborns, clinicians must be familiar with its diagnosis and treatment.
SORT: KEY RECOMMENDATIONS FOR PRACTICE
| Clinical recommendation | Evidence rating | References | Comments |
|---|---|---|---|
| Noninvasive ventilation, commonly using nasal continuous positive airway pressure, may replace invasive intubation because of improved clinical and financial outcomes. | B | 15 | Randomized controlled trial |
| The minimum required amount of surfactant is 100 mg per kg. Initial administration of 200 mg per kg can result in significant improvement in oxygenation and decreased need to retreat. | B | 17, 18 | Randomized controlled trials |
| The INSURE (intubate, administer surfactant, extubate to nasal continuous positive airway pressure) strategy should be used to reduce mechanical ventilation, air leak syndromes, and progression to bronchopulmonary dysplasia. | B | 19 | Cochrane review |
| Antenatal corticosteroids given between 24 and 34 weeks' gestation decrease respiratory distress syndrome risk with a number needed to treat of 11. | C | 6 | Consensus guidelines |
| The U.S. Department of Health and Human Services recommends screening newborns for critical congenital heart defects using pulse oximetry before hospital discharge, but at least 24 hours after birth. | C | 53 | Prospective study |
A = consistent, good-quality patient-oriented evidence; B = inconsistent or limited-quality patient-oriented evidence; C = consensus, disease-oriented evidence, usual practice, expert opinion, or case series. For information about the SORT evidence rating system, go to https://www.aafp.org/afpsort.
WHAT IS NEW ON THIS TOPIC: NEWBORN RESPIRATORY DISTRESS
The U.S. Department of Health and Human Services recommends routine pulse oximetry over physical examination alone as a screening strategy for critical congenital heart disease.
Maternal selective serotonin reuptake inhibitor use late in pregnancy is associated with a small absolute increased risk for persistent pulmonary hypertension of the newborn.
Reduction of premature births and cesarean deliveries decreases respiratory distress cases, with prenatal care being crucial to prevention. Women with inadequate prenatal care may deliver babies with lower birth weights and increased risk of admission to the neonatal intensive care unit.5 Antenatal corticosteroid use...