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Respiratory distress

Dr Victoria Kain introduces some of the more common conditions relating to respiratory distress in the newborn, including RDS, TTN and pneumonia.

Respiratory distress is common in newborn babies – particularly premature babies. Let’s begin by reviewing the normal pattern of a baby’s breathing in this first video.

This is an additional video, hosted on YouTube.

What are your observations? How would you describe in your own words what the normal breathing pattern looks and sounds like?

How does respiratory distress sound?

In comparison to the first video, listen to the respiratory distress this term baby is experiencing. What differences do you notice?

This is an additional video, hosted on YouTube.

Let’s briefly consider the more common respiratory conditions you are likely to encounter in an assessment of the newborn.

Respiratory Distress Syndrome (RDS)

RDS most commonly occurs in premature babies, primarily due to the insufficiency of a lipoprotein that is produced by the type II alveolar cells – called surfactant. Surfactant is a slippery substance that has a detergent-like effect on the alveoli in the lungs. The alveoli are the tiny air sacs in the lungs. The surfactant prevents the lungs from collapsing at the end of every breath. The more premature the baby is, the less surfactant they have available. Unfortunately the store they are born with rapidly depletes after birth.

Low levels of surfactant can cause profound respiratory distress in the newborn and a distinctive ‘grunting’ sound as the newborn tries to create an ‘end’ pressure in the lung to prevent the alveoli from collapsing. The newborn quickly becomes exhausted. Babies with RDS can be given surfactant directly into their lungs, which can help to reduce the severity of the condition in both preterm and term babies alike.

In the next video example, listen for the distinctive ‘grunt’ this baby makes. Before playing, please be advised this clip is quite distressing to watch.

This is an additional video, hosted on YouTube.

Transient tachypnoea of the Newborn (TTN)

This common condition is also known as ‘wet lung’. It is one of the most common respiratory disorders seen in the neonate. It occurs due to inadequate or delayed clearance of fetal alveolar fluid. Fortunately, the condition is self-limiting and usually resolves within 48 to 72 hours. Babies may require oxygen therapy during this time.


Pneumonia (lung infection) is commonly treated in newborn care, particularly in developing countries. Bacterial, viral and fungal agents can all cause pneumonia. Pneumonia causes respiratory distress as well as problems in other body systems, due to inflammation and infection.

Your task

Post your comments about the differences you can see and hear between normal breathing in the newborn and a baby in respiratory distress. Please also feel free to share your stories and experiences about respiratory conditions in the newborn.


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

© Griffith University
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Assessment of the Newborn

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