Breathing difficulties in the newborn

See Breathing difficulties in the YI for respiratory problems in the young infant.

Learning objectives

After completion of this session participants should be able to:

Why are breathing difficulties in the new-born so important?

Breathing difficulties are the most common way that sick neonates present to the healthcare worker. There are several different possible diagnoses and these need to be considered in order to provide the correct management.

Newborns at risk of developing breathing problems

Signs and symptoms

Possible causes

Respiratory Distress Syndrome

  • RDS occurs primarily in premature infants; its incidence is inversely related to gestational age and birthweight.
  • It occurs in 60–80% of infants less than 28 weeks, 15–30% of those between 32 and 36 weeks, about 5% beyond 37 weeks, and rarely at term.
  • Surfactant deficiency is the primary cause of RDS.
  • Increased risk in maternal diabetes, multiple births, Caesarian Section, precipitous delivery, asphyxia, cold stress, and a history of previously affected infants.
  • Reduced risk with antenatal steroid use.
  • Management: oxygen, CPAP, ventilation, antibiotics, NGT

Management of breathing difficulties in the newborn

Consider CPAP if the newborn condition does not improve.

Continuous positive airway pressure therapy is recommended for the treatment of preterm newborns with Respiratory Distress Syndrome and should be started as soon as the diagnosis is made (5).


Definition: cessation of breathing for longer than 20 seconds which may be associated with bradycardia. It may be primary due to prematurity or secondary to other conditions such as:

Investigations - AFTER clinical examination

Blood sugar
Packed cell volume
Sepsis work-up (blood culture, urine culture, LP, CXR

Consider the possibility that the baby could be having a seizure: If mobile ultrasound is available, perform cranial ultrasound to look for brain bleeds.


Determine cause and treat

General measures: tactile stimulation, correct anaemia, maintain normal body temperature, look for electrolyte imbalance, intraventricular haemorrhage, signs or symptoms of sepsis, patent ductus arteriosus, necrotising enterocolitis and gastro-oesophageal reflux, and treat accordingly.

Give aminophylline for prevention of apnoeas of prematurity.

Aminophylline doses: 6mg/kg PO stat to load (may also be given IV over 20 min) followed by 2.5mg/kg bd (twice daily) PO (may also be given IV).
Dissolve 100mg tablets in 20mls of water, each ml of solution contains 5mg of aminophylline

See doses of oral aminophylline when using a solution made from a tablet.

When to start aminophylline

About 25% of neonates <34 weeks have apnoeas of prematurity. Therefore it is reasonable to start aminophylline prophylactically to all premature infants of gestational age <34 weeks or weight <1800 grams.

When to stop aminophylline

The gestational age >37 weeks (or weight of > 2500 g if gestational age is not known)
The infant has been apnoea-free for 7 days.