Use this link to watch a 10-minute video about respiratory distress in the

newborn.
https://www.youtube.com/watch?v=j3ypUlLMRLs

After watching the video about respiratory distress in the newborn.

1. Mention 5 common symptoms and signs?
Tachypnea
Retractions
Nasal flaring
Grunting
Cyanosis

2. What is the normal respiratory rate in a newborn?

30 – 60 breaths per minute
3. What is the most common cause in a full term newborn?
TTN
4. What is the most common cause in a 32-week preterm newborn?
RDS
5. Mention three main factors you should ask about in a baby presented with
respiratory difficulty immediately after birth?
Birth wight ?
Gestational age?
Meconium stained amniotic fluid (yellowish-greenish)?

Case scenario 1
You were called to examine a 3.8 kg male newborn delivered by elective Cesarean
section due to breech presentation in labor at 38.5 weeks. The baby was
breathing at 70/ min with minimal retractions.
1. What is the most likely diagnosis?
TTN
 2. Name 2 risk factors?
Male
Born <39 weeks of gestational age
3. What do you expect on chest auscultation?
Lung fields may be clear or crackers
4. What are the main CXR findings?
Fluid in the interlobar fissure
Hyper expanded lungs with flattened diaphragm
"Sunburst" pattern prominent vasculature
Fluffy densities of alveolar edema (sometimes)

Case scenario 2
You were called to examine a 4.2 kg male newborn delivered by emergency
Cesarean section at 40 weeks due to fetal distress. The baby was delivered
covered by yellowish-greenish fluid. After resuscitation, he was breathing at 80/
min with minimal retractions.
1. What is the most likely diagnosis? MAS
2. Name the main risk factor? Meconium stained amniotic fluid
 3. What are the main CXR findings?

Hyperinflation
Flattened diaphragms
Diffuse, patchy densities alternating with areas of expansion

4. What is the pathophysiologic mechanism for this respiratory pathology?

Release of cytokines and Proinflammatory factors

Obstruction of airways
→ gas trapping
→ alveolar rupture
Deactivation and Decreased synthesis of Surfactant

5. What is the clinical sign upon inspection of chest?

Tachypnea
Retractions
Grunting

Q. Match the following CXR findings with the corresponding respiratory

pathology?
A. RDS
B. TTN
C. MAS
1……RDS……………………..
2………MAS………………………
3……………TTN…………………

Q. Regarding pneumothorax, mention:

1. Two clinical exam findings:
A. Hyper-resonance to
percussion
B. Decreased or absence breath sounds
2. Two CXR findings:
A. Collapsed affected lung
B. Mediastinal shift to the opposite side
3. What are the main findings suggestive for chylothorax in analysis of pleural
fluid?
A. High Triglycerides content) probably greater than 110 mg/dL(
B. Total cholesterol level less than 200 mg/dL
C. Detection of chylomicrons
D. Rich in lymphocytes (accounting for 80% of all the cells)

Which of the following ABG results is expected in a 28-week preterm baby with
RDS who is 30-minute old and is showing signs of respiratory distress?
(PH/PaCO2/HCO3/Base excess)
A. 7.5/55/28/+8
B. 7.2/25/18/-8
C. 7.2/65/26/1
D. 7.5/30/30/6
What is the acid-base disturbance identified in your selection for the question
above?
Respiratory acidosis