![]() ![]() These infants may be tachypneic with respiratory rates of up to 100 breaths per minute. Infants with mild Transient Tachypnea of the Newborn (TTN) will demonstrate signs of mild-to-moderate respiratory distress for 1-2 hours following delivery. The distinction between normal or difficult transition and more significant respiratory disease is based on the severity and duration of symptoms. The presence of risk factors for sepsis or underlying respiratory disease suggests the need for earlier, more aggressive intervention than might be warranted for an infant with no risk factors. Table 3 identifies the most common respiratory problems in the newborn. Infants who present with these signs warrant careful examination, including a review of antepartum and intrapartum history. Signs of respiratory distress include grunting, nasal flaring, retractions and tachypnea. TABLE 2: Risk factors for problems in transition Presence of meconium stained amniotic fluid Narcotic or magnesium sulphate administration Premature or prolonged rupture of membranes The clinician must weigh the clinical presentation and history of the baby to determine the degree of intervention required. Table 2 outlines some of the factors that place the infant at risk of problems in transition. These risk factors may be maternal, or occur in the antepartum, intrapartum or immediate postpartum period. The presence of risk factors increases the likelihood that an infant will experience a delayed or complicated transition. Moderate-to-severe respiratory distress: grunting, flaring, marked retractions and need for supplemental oxygen beyond 2 hours of age.Symptoms of greater than 2 hours' duration.Depending on the severity of the symptoms and the infant’s risk factors, the healthcare team may elect to initiate medical treatment early in the transition period rather than wait for the symptoms to progress. However, infants with serious illnesses will deteriorate over time and may require increasing levels of support to maintain stability.Ĭlinical deterioration should raise a red flag with caregivers (see Table 1). Infants with underlying pathology such as infection, respiratory or cardiac disease may initially exhibit the same symptoms as those with mild transition problems. ![]() This paper discusses common findings in transition that must be evaluated to differentiate infants experiencing a delayed transition from those with underlying disease processes. Timely interventions which support thermal stability, adequate blood glucose levels and adequate oxygenation will prevent infants with a complicated transition from experiencing unnecessary morbidity or mortality. These infants must be observed closely to ensure that these signs are not indicative of underlying disease. As outlined in Part 1 of this series, the transition from fetal to neonatal life requires complex physiological changes which must occur in a short period of time.Ī small percentage of neonates experience disturbances in the normal transitional process, displaying signs of mild-to-moderate respiratory distress, mild temperature instability or borderline blood sugars. ![]()
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