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Newborn Respiratory Distress: Evaluation and Management

Katie L. Buel, DO
Emily Gould, MD

American Family Physician. 2026;113(1):35-41.

Author disclosure: No relevant financial relationships.

This clinical content conforms to AAFP criteria for CME.

Newborn respiratory distress is one of the most common reasons for neonatal intensive care admission at birth. If not diagnosed and managed appropriately, newborn respiratory distress can progress to cardiopulmonary collapse and death. Presenting symptoms of respiratory distress consist of increased work of breathing (eg, grunting, nasal flaring, cyanosis, retractions, respiratory rate greater than 60 breaths/min [tachypnea]). The most common cause of respiratory distress at term is transient tachypnea of the newborn. Other causes include respiratory distress syndrome, meconium aspiration syndrome, pneumonia, and sepsis. Less common causes are pneumothorax, congenital heart disease, and congenital diaphragmatic hernia. Physicians attending deliveries should be familiar with current neonatal resuscitation guidelines. If respiratory distress does not resolve after stabilization in the delivery room, chest radiography, supplemental oxygen, and appropriate laboratory tests (eg, complete blood cell count, blood cultures, C-reactive protein, blood gas measurement) should be considered. The Early-Onset Sepsis Calculator can help guide decision-making for neonates who may require antibiotic therapy.

Newborn respiratory distress is defined as increased work of breathing, including grunting, nasal flaring, cyanosis, retractions, and respiratory rate greater than 60 breaths/min. Up to 10% of neonates may require respiratory support immediately after delivery.1 Approximately 5% of term newborns require more advanced resuscitation beyond drying and stimulation.2

WHAT'S NEW ON THIS TOPIC

Neonatal Respiratory Distress
Approximately 5% of term newborns require more advanced resuscitation beyond drying and stimulation.
2023 updates to the American Heart Association guideline on neonatal resuscitation include changes to umbilical cord management and use of effective positive pressure ventilation.
Routine endotracheal suctioning is no longer recommended because of the risk of complications with no decreased incidence of meconium aspiration syndrome.

SORT: KEY RECOMMENDATIONS FOR PRACTICE

Clinical recommendationEvidence ratingComments
Rapid evaluation of the neonate within the first minute is crucial and includes heart rate assessment and evaluation for signs of apnea, gasping, labored breathing, or persistent cyanosis. Initial steps for managing distress include warming the newborn to maintain normothermia, drying and stimulating the newborn, positioning the airway, and clearing secretions if needed.2,3 CConsensus guidelines
Maternal corticosteroids are recommended in pregnancy when there is risk of preterm delivery or with ruptured membranes between 24 0/7 weeks' and 36 6/7 weeks' gestation to reduce the risk of respiratory distress syndrome.33–35 ACochrane review, randomized controlled trial, consensus guideline
The Early-Onset Sepsis Calculator should be applied for neonates born at 35 weeks' gestation or greater with respiratory distress to guide laboratory evaluation and antibiotic administration.10,11,17 CCohort study, expert opinion

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.

Globally, respiratory distress is one of the most common reasons for neonatal intensive care unit admission at birth.1 If not diagnosed and managed appropriately, newborn respiratory distress can progress to cardiopulmonary collapse and death.

KATIE L. BUEL, DO, is an assistant professor of clinical family medicine at the Indiana University School of Medicine, Indianapolis.

EMILY GOULD, MD, is an assistant professor of clinical family medicine at the Indiana University School of Medicine, Indianapolis.

Address correspondence to Katie L. Buel, DO, at kbuel@gmail.com.

Author disclosure: No relevant financial relationships.

  1. 1.Pramanik AK, Rangaswamy N, Gates T. Neonatal respiratory distress: a practical approach to its diagnosis and management. Pediatr Clin North Am. 2015;62(2):453-469.
  2. 2.Aziz K, Lee HC, Escobedo MB, et al. Part 5: neonatal resuscitation: 2020 American Heart Association guidelines for cardiopulmonary resuscitation and emergency cardiovascular care. Circulation. 2020;142(16 suppl 2):S524-S550.
  3. 3.Weiner GM, Zaichkin J, eds. Textbook of Neonatal Resuscitation. 8th ed. American Academy of Pediatrics; 2021.
  4. 4.Yamada NK, Szyld E, Strand ML, et al. 2023 American Heart Association and American Academy of Pediatrics focused update on neonatal resuscitation: an update to the American Heart Association guidelines for cardiopulmonary resuscitation and emergency cardiovascular care. Circulation. 2024;149(1):e157-e166.
  5. 5.Wyckoff MH, Wyllie J, Aziz K, et al. Neonatal life support: 2020 international consensus on cardiopulmonary resuscitation and emergency cardiovascular care science with treatment recommendations. Circulation. 2020;142(16 suppl 1):S185-S221.
  6. 6.Hermansen CL, Mahajan A. Newborn respiratory distress. Am Fam Physician. 2015;92(11):994-1002.
  7. 7.Reuter S, Moser C, Baack M. Respiratory distress in the newborn. Pediatr Rev. 2014;35(10):417-428 , quiz 429.
  8. 8.Hermansen CL, Lorah KN. Respiratory distress in the newborn. Am Fam Physician. 2007;76(7):987-994.
  9. 9.Alhassen Z, Vali P, Guglani L, et al. Recent advances in pathophysiology and management of transient tachypnea of newborn. J Perinatol. 2021;41(1):6-16.
  10. 10.Kaiser Permanente Division of Research. Neonatal Early-Onset Sepsis Calculator. Accessed April 10, 2025. https://neonatalsepsiscalculator.kaiserpermanente.org/
  11. 11.Kuzniewicz MW, Escobar GJ, Forquer H, et al. Update to the Neonatal Early-Onset Sepsis Calculator utilizing a contemporary cohort. Pediatrics. 2024;154(4):e2023065267.
  12. 12.Bruschettini M, Hassan KO, Romantsik O, et al. Interventions for the management of transient tachypnoea of the newborn—an overview of systematic reviews. Cochrane Database Syst Rev. 2022(2):CD013563.
  13. 13.Monfredini C, Cavallin F, Villani PE, et al. Meconium aspiration syndrome: a narrative review. Children (Basel). 2021;8(3):230.
  14. 14.Osman A, Halling C, Crume M, et al. Meconium aspiration syndrome: a comprehensive review. J Perinatol. 2023;43(10):1211-1221.
  15. 15.Rubarth LB, Quinn J. Respiratory development and respiratory distress syndrome. Neonatal Netw. 2015;34(4):231-238.
  16. 16.Hooven TA, Polin RA. Pneumonia. Semin Fetal Neonatal Med. 2017;22(4):206-213.
  17. 17.Briggs-Steinberg C, Roth P. Early-onset sepsis in newborns. Pediatr Rev. 2023;44(1):14-22.
  18. 18.Jovandaric MZ, Milenkovic SJ, Dotlic J, et al. Neonatal pneumothorax outcome in preterm and term newborns. Medicina (Kaunas). 2022;58(7):965.
  19. 19.Puri K, Allen HD, Qureshi AM. Congenital heart disease. Pediatr Rev. 2017;38(10):471-486.
  20. 20.Jullien S. Newborn pulse oximetry screening for critical congenital heart defects. BMC Pediatr. 2021;21(suppl 1):305.
  21. 21.Longoni M, Pober BR, High FA, et al. Congenital diaphragmatic hernia overview. GeneReviews. February 1, 2006. Updated November 5, 2020. Accessed November 26, 2024. https://www.ncbi.nlm.nih.gov/books/NBK1359/
  22. 22.Baudat-Nguyen J, Schneider J, Roth-Kleiner M, et al. Incidence and management of neonatal pneumothorax in a 10-hospital regional perinatal network in Switzerland: a retrospective observational study. Am J Perinatol. 2024;41(S 01):e3305-e3312.
  23. 23.Li CS, Chu SM, Lien R, et al. Prospective investigation of serial ultrasound for transient tachypnea of the newborn. Pediatr Neonatol. 2021;62(1):64-69.
  24. 24.Moresco L, Bruschettini M, Macchi M, et al. Salbutamol for transient tachypnea of the newborn. Cochrane Database Syst Rev. 2021(2):CD011878.
  25. 25.Dehdashtian M, Aramesh MR, Melekian A, et al. Restricted versus standard maintenance fluid volume in management of transient tachypnea of newborn: a clinical trial. Iran J Pediatr. 2014;24(5):575-580.
  26. 26.Gallo DM, Romero R, Bosco M, et al. Meconium-stained amniotic fluid. Am J Obstet Gynecol. 2023;228(5S):S1158-S1178.
  27. 27.Olicker AL, Raffay TM, Ryan RM. Neonatal respiratory distress secondary to meconium aspiration syndrome. Children (Basel). 2021;8(3):246.
  28. 28.Beligere N, Rao R. Neurodevelopmental outcome of infants with meconium aspiration syndrome: report of a study and literature review. J Perinatol. 2008;28(suppl3):S93-S101.
  29. 29.Chen IL, Chen HL. New developments in neonatal respiratory management. Pediatr Neonatol. 2022;63(4):341-347.
  30. 30.Starship. Parenchymal lung disease. Accessed November 26, 2024. https://www.starship.org.nz/health-professionals/parenchymal-lung-disease/
  31. 31.Sweet DG, Carnielli VP, Greisen G, et al. European consensus guidelines on the management of respiratory distress syndrome: 2022 update. Neonatology. 2023;120(1):3-23.
  32. 32.Härtel C, Herting E, Humberg A, et al. Association of administration of surfactant using less invasive methods with outcomes in extremely preterm infants less than 27 weeks of gestation. JAMA Netw Open. 2022;5(8):e2225810.
  33. 33.Committee on Obstetric Practice. Committee Opinion No. 713: antenatal corticosteroid therapy for fetal maturation. Obstet Gynecol. 2017;130(2):e102-e109.
  34. 34.Walters AGB, Lin L, Crowther CA, et al. Betamethasone for preterm birth: Auckland Steroid Trial full results and new insights 50 years on. J Pediatr. 2023;255:80-88.e5.
  35. 35.McGoldrick E, Stewart F, Parker R, et al. Antenatal corticosteroids for accelerating fetal lung maturation for women at risk of preterm birth. Cochrane Database Syst Rev. 2020(12):CD004454.
  36. 36.Alriyami A, Kiger JR, Hooven TA. Ventilator-associated pneumonia in the neonatal intensive care unit. Neoreviews. 2022;23(7):e448-e461.
  37. 37.Glaser MA, Hughes LM, Jnah A, et al. Neonatal sepsis: a review of pathophysiology and current management strategies. Adv Neonatal Care. 2021;21(1):49-60.
  38. 38.Pinninti SG, Kimberlin DW. Neonatal herpes simplex virus infections. Semin Perinatol. 2018;42(3):168-175.
  39. 39.Ginsburg AS, Meulen AS, Klugman KP. Prevention of neonatal pneumonia and sepsis via maternal immunisation. Lancet Glob Health. 2014;2(12):e679-e680.
  40. 40.Jhaveri V, Vali P, Giusto E, et al. Pneumothorax in a term newborn. J Perinatol. 2024;44(4):465-471.
  41. 41.Abbasi N, Backley S, Ryan G, et al. Prenatal diagnosis and risk stratification of congenital diaphragmatic hernia. World J Pediatr Surg. 2024;7(4):e000892.
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