Table 3.

Differential Diagnosis of Respiratory Distress in the Newborn

Airway

Nasal obstruction, choanal atresia, micrognathia, Pierre Robin sequence, macroglossia, congenital high airway obstruction syndrome, including laryngeal or tracheal atresia, subglottic stenosis, laryngeal cyst or laryngeal web, vocal cord paralysis, subglottic stenosis, airway hemangiomas or papillomas, laryngomalacia, tracheobronchomalacia, tracheoesophageal fistula vascular rings, and external compression from a neck mass

Pulmonary

RDS,a TTN,a MAS,a neonatal pneumonia,a pneumothorax,a PPHN,a pleural effusion (congenital chylothorax), pulmonary hemorrhage, bronchopulmonary sequestration, bronchogenic cyst, congenital cystic adenomatoid malformation or congenital pulmonary airway malformation, pulmonary hypoplasia, congenital lobar emphysema, pulmonary alveolar proteinosis, alveolar capillary dysplasia, congenital pulmonary lymphangiectasis, and surfactant protein deficiency

Cardiovascular

Cyanotic and select acyanotic congenital heart defects,a neonatal cardiomyopathy, pericardial effusion or cardiac tamponade, fetal arrhythmia with compromised cardiac function, and high-output cardiac failure

Thoracic

Pneumomediastinum, chest wall deformities, mass, skeletal dysplasia, and diaphragmatic hernia or paralysis

Neuromuscular

Central nervous system injury (birth trauma or hemorrhage),a hypoxic-ischemic encephalopathy,a cerebral malformations, chromosomal abnormalities, medication (neonatal or maternal sedation, antidepressants, or magnesium), congenital TORCH infections, meningitis, seizure disorder, obstructed hydrocephalus, arthrogryposis, congenital myotonic dystrophy, neonatal myasthenia gravis, spinal muscular atrophy, congenital myopathies, and spinal cord injury

Other

Sepsis,a hypoglycemia,a metabolic acidosis,a hypothermia or hyperthermia, hydrops fetalis, inborn error of metabolism, hypermagnesemia, hyponatremia or hypernatremia, severe hemolytic disease, anemia, and polycythemia

BPD=bronchopulmonary dysplasia; MAS=meconium aspiration syndrome; PPHN=persistent pulmonary hypertension of the newborn; RDS=respiratory distress syndrome; TTN=transient tachypnea of the newborn.

^aRelatively common causes of respiratory distress in the newborn.