Assessing respiration

We next assess the baby’s chest, to listen to breathing and visually check structure.

To observe the chest, begin by simply observing the baby at rest. Note the shape of the chest – it should be cylindrical and symmetrical. Symmetry between the two sides of the chest is important, as asymmetry may indicate pneumothorax (an air leak).

Observe and gently palpate the nipples – there should be 2 nipples, however an extranumerary (3rd) nipple is not uncommon. The nipples should be symmetrical and in the midclavicular line. This is an imaginary line parallel to the chest bone, passing through the midpoint of the clavicle (collar bone). There should be an equal space between the nipples, and the areola should be visible in the term newborn. There may also be small secretions (sometimes referred to as ‘witch’s milk’) which is a normal finding in both female and male newborns (Kain & Mannix, 2018).

Use the stethoscope to listen to the lungs (auscultation). This will allow you to ensure the lung sounds are clear, bilateral and equal. It is not unusual for there to be some rales (slight bubbling or rattling sounds) heard for a few hours after birth.

The normal respiratory rate of the newborn should be less than 60 breaths per minute, but more than 40. Breathing may be periodic (irregular) in the neonatal period. You would be concerned about signs of respiratory distress and apnoeic episodes, where the baby stops breathing for more than 20 seconds at a time (Queensland Clinical Guideline, 2014).

Your task

If you have questions or comments about any aspect of assessing the newborn’s chest, please post them in the comments section below. We’ll be learning how to assess the newborn’s heart rate in the next step.

References

Kain. V & Mannix, T (2018). Neonatal Nursing in Australia and New Zealand, 1st Edition. Australia: Elsevier

Queensland Clinical Guideline (2014). Routine newborn assessment.