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Newborn and Infant Care

Respiratory Distress

03/15/2010

Question:

We have a 2 day old newborn, just released home today, she had problems with her lungs developing before birth and now that we are home she continually "snorts" and sneezes. Her breathing has slightly gotten faster since we have been home. Suctioning with the bulb syringe does not seem to help. What else can I try?

Answer:

This must be a very worrisome time for you! With such a new baby with early problems in lung development, it would be safest to call her doctor now and make an appointment to be seen today. If you baby's color is blue in the face and mouth or on her chest and tummy, she should be taken to the nearest children's emergency room. If that is a distance away or you have no one to drive you for care, call the paramedics.

Other important signs of respiratory distress and the need for immediate care include a respiratory rate above 60 breaths per minute at rest. You can count her respirations for a full minute timing them with a clock with a second hand. We count for a full minute with babies because their breathing rate is often not regular as it is in older children and adults. A respiratory rate over 60 in a quiet baby is too high. She should be seen by her doctor.

It is also a problem if she an "uhh!" sound every time she breathes out. This is called grunting and shows that she is working hard to breathe. Another visible sign of breathing being hard for a baby is flaring out of the nostrils with every intake of air. Finally, lift her shirt and watch her breathing on her chest and tummy. If the skin sinks in as she inhales between her ribs and under her collar bones (clavicles) she is having trouble breathing. All of these signs of breathing hard mean she needs to see a doctor right away.

All of this being said, babies are noisy breathers because their nasal airways are so tiny that even a small amount of mucus in the nose narrows her airway. Sometimes you need to place 1 or 2 drops of sterile salt water (saline drops) in each nostril to loosen mucus and help the bulb syringe remove it. You can purchase these drops in any drug store and no precription is needed.

Sometimes there is narrowing or collapse of a part of her airway that makes the baby have a sharp sound with every breath in. It is a good idea to have her doctor check her out and let you know that she has "stridor." It sounds scary but usually does not cause any problems in breathing and decreases as she grows.

All good doctors understand that a new baby is a very vulnerable tiny human. babies can become very ill quickly. Parents are their baby's voice, so don't hesitate to call for help if you think something is wrong. Bringing home a new baby is a big responsibility. It is far better to be safe than sorry.

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Response by:

Mary M Gottesman, PhD, RN, CPNP, FAAN Mary M Gottesman, PhD, RN, CPNP, FAAN
Professor of Clinical Nursing
College of Nursing
The Ohio State University