Breathing difficulties in newborns

Breathing difficulties are common soon after birth and can include apnea, blue color, grunts, wheezes, vibration of the nose, poor appetite, and rapid breathing. Contractions between the ribs, stomach, and collarbone are often seen as an expression of struggling to breathe.

What could it be?

Respiratory distress syndrome, meconium aspiration syndrome, and other uncommon causes can cause breathing difficulties in newborns, but they are typically harmless and transient. 

Transient rapid breathing

The most common cause of breathing difficulties in newborns is residual amniotic fluid in the lung tissue after birth. It manifests immediately after birth or within two hours, and symptoms can last from a few hours to a few days. X-ray of the lungs can show typical changes.

Respiratory distress syndrome

The lungs’ immaturity and a deficiency in surfactant, which speeds up lung maturation, are the causes of respiratory distress syndrome. It is more common among boys and is six times higher in infants born to mothers with diabetes. It is suspected when grunting, withdrawals, and other symptoms of discomfort are observed in premature babies soon after birth. X-rays can show typical changes.

Meconium aspiration syndrome

Meconium is a “contaminated” amniotic fluid containing waste from the fetus. It is locally irritating and prevents air from entering the lungs. It can be an expression of oxygen deficiency or stress in the child inside the womb. Meconium-stained amniotic fluid occurs in 10-15% of births and causes breathing difficulties immediately after birth. X-rays of the lungs can also show changes.


Bacteria that have entered the lungs are to blame. In the case of a prolonged birth after the amniotic fluid has broken, premature birth, and fever in the mother during birth, there is an increased risk of pneumonia in the new-born child. This is a less common cause than the others mentioned above. The disease can progress in a variety of ways, but the most noticeable symptoms are difficulty breathing and fever. Breathing difficulties are only detected hours to days after birth because the condition develops over time. Lung X-rays can reveal typical changes. Bacteria can be found in blood.

Rarer causes

A lung puncture (pneumothorax) can happen for no apparent reason or as a result of another complication. The incidence is 1-2% among children born at term, but rises to around 6% in premature births. Certain congenital malformations, such as congenital heart disease, nervous system damage, and congenital metabolic diseases.

The diagnosis

The time of birth in relation to the due date tells us a lot about what condition is present. Any clarification of birth-related issues can also provide hints about the underlying cause. The medical exam is critical. Other tests that may be called into question include x-rays of the lungs, pulse and oxygen measurements, and blood tests.


General measures include oxygen supply, mechanical ventilation (respirator), blood clot prevention, and possibly artificial nutrition if the child is critically ill. If the child is not breathing or is breathing very poorly, resuscitation may be required.

If the child has respiratory distress syndrome, he or she is given surfactant and cortisol, preferably before birth 3-4. It was previously common in the case of meconium aspiration syndrome to suck the contaminated amniotic fluid up from the airways. Recent research has revealed that it is not always necessary. Temporary breathing difficulties require only oxygen supplementation because the condition resolves on its own.


Children who survive respiratory distress syndrome frequently require extensive hospitalization. These children have a lower quality of life after discharge, are weakened due to the condition’s impact on the nervous system and muscles, have poorer mental development than other children, and are at a higher risk of dying.



4th Professional Medical Student. Karachi Medical and Dental College.

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