Hermansen Christian L, Mahajan Anand
Lancaster General Hospital, Lancaster, PA, USA.
Am Fam Physician. 2015 Dec 1;92(11):994-1002.
Newborn respiratory distress presents a diagnostic and management challenge. Newborns with respiratory distress commonly exhibit tachypnea with a respiratory rate of more than 60 respirations per minute. They may present with grunting, retractions, nasal flaring, and cyanosis. Common causes include transient tachypnea of the newborn, respiratory distress syndrome, meconium aspiration syndrome, pneumonia, sepsis, pneumothorax, persistent pulmonary hypertension of the newborn, and delayed transition. Congenital heart defects, airway malformations, and inborn errors of metabolism are less common etiologies. Clinicians should be familiar with updated neonatal resuscitation guidelines. Initial evaluation includes a detailed history and physical examination. The clinician should monitor vital signs and measure oxygen saturation with pulse oximetry, and blood gas measurement may be considered. Chest radiography is helpful in the diagnosis. Blood cultures, serial complete blood counts, and C-reactive protein measurement are useful for the evaluation of sepsis. Most neonates with respiratory distress can be treated with respiratory support and noninvasive methods. Oxygen can be provided via bag/mask, nasal cannula, oxygen hood, and nasal continuous positive airway pressure. Ventilator support may be used in more severe cases. Surfactant is increasingly used for respiratory distress syndrome. Using the INSURE technique, the newborn is intubated, given surfactant, and quickly extubated to nasal continuous positive airway pressure. Newborns should be screened for critical congenital heart defects via pulse oximetry after 24 hours but before hospital discharge. Neonatology consultation is recommended if the illness exceeds the clinician's expertise and comfort level or when the diagnosis is unclear in a critically ill newborn.
新生儿呼吸窘迫带来了诊断和管理方面的挑战。患有呼吸窘迫的新生儿通常表现为呼吸急促，呼吸频率超过每分钟60次。他们可能会出现呻吟、三凹征、鼻翼扇动和发绀。常见原因包括新生儿短暂性呼吸急促、呼吸窘迫综合征、胎粪吸入综合征、肺炎、败血症、气胸、新生儿持续肺动脉高压以及过渡延迟。先天性心脏病、气道畸形和先天性代谢缺陷是较不常见的病因。临床医生应熟悉最新的新生儿复苏指南。初始评估包括详细的病史和体格检查。临床医生应监测生命体征，并用脉搏血氧仪测量血氧饱和度，也可考虑进行血气测量。胸部X线摄影有助于诊断。血培养、连续血常规检查和C反应蛋白测量对败血症的评估很有用。大多数患有呼吸窘迫的新生儿可以通过呼吸支持和非侵入性方法进行治疗。可通过面罩/气囊、鼻导管、氧帐和鼻持续气道正压通气提供氧气。在更严重的情况下可能需要使用呼吸机支持。表面活性剂越来越多地用于治疗呼吸窘迫综合征。采用INSURE技术时，先将新生儿插管，给予表面活性剂，然后迅速拔管至鼻持续气道正压通气。应在出生后24小时至出院前通过脉搏血氧仪对新生儿进行严重先天性心脏病筛查。如果病情超出临床医生的专业知识和舒适水平，或危重新生儿的诊断不明确，建议咨询新生儿科。
