Some newborns struggle to breathe in the first hours of life because of retained lung fluid, immature lungs, infection or meconium. Fast breathing, grunting and retractions need quick assessment and support, since a newborn tires fast.
Key symptoms
- Breathing faster than 60 breaths a minute
- Grunting with each breath out
- Nasal flaring and the chest wall pulling in
- Blue color around the lips or poor feeding
What you find on exam
- Respiratory rate, oxygen saturation (right hand and a foot) and temperature
- Retractions, head bobbing and air entry on both sides
- Heart rate, murmurs and capillary refill
- Gestational age and signs of infection
Tests
- Chest X-ray: wet lungs, ground glass, patchy infiltrates or air leak
- Blood gas and glucose
- Blood count, CRP and blood culture for sepsis
- Echocardiogram if heart disease is suspected
Treatment basics
- Warm, dry and stimulate; clear the airway if needed
- Oxygen to target saturation; CPAP for increasing work of breathing
- Surfactant for preterm babies with respiratory distress syndrome
- Antibiotics such as ampicillin and gentamicin if sepsis is possible
- Bag-mask ventilation if the heart rate drops below 100
Red flags
- Apnea or heart rate below 100
- Cyanosis that does not improve with oxygen
- Sudden worsening suggesting a pneumothorax
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Sources: NCCPA PANCE Content Blueprint; NCSBN 2026 NCLEX-RN Test Plan; NREMT psychomotor skill sheets (EMT and Paramedic). Written by Making Synapses. Making Synapses is not affiliated with these organizations.