Neonatology consultation is recommended if the illness exceeds the clinician's expertise and comfort level or when the diagnosis is unclear in a critically ill newborn. Newborns should be screened for critical congenital heart defects via pulse oximetry after 24 hours but before hospital discharge. Using the INSURE technique, the newborn is intubated, given surfactant, and quickly extubated to nasal continuous positive airway pressure. Surfactant is increasingly used for respiratory distress syndrome. Ventilator support may be used in more severe cases. Oxygen can be provided via bag/mask, nasal cannula, oxygen hood, and nasal continuous positive airway pressure. Most neonates with respiratory distress can be treated with respiratory support and noninvasive methods. Blood cultures, serial complete blood counts, and C-reactive protein measurement are useful for the evaluation of sepsis. Chest radiography is helpful in the diagnosis. The clinician should monitor vital signs and measure oxygen saturation with pulse oximetry, and blood gas measurement may be considered. Initial evaluation includes a detailed history and physical examination. Clinicians should be familiar with updated neonatal resuscitation guidelines. Congenital heart defects, airway malformations, and inborn errors of metabolism are less common etiologies. Common causes include transient tachypnea of the newborn, respiratory distress syndrome, meconium aspiration syndrome, pneumonia, sepsis, pneumothorax, persistent pulmonary hypertension of the newborn, and delayed transition. They may present with grunting, retractions, nasal flaring, and cyanosis. Newborns with respiratory distress commonly exhibit tachypnea with a respiratory rate of more than 60 respirations per minute. Newborn respiratory distress presents a diagnostic and management challenge.
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