Tachypnea (RR >60/min) accompanied by chest retractions and/or grunt.

---

Aetiology

Pulmonary causes

Cause	Time of onset	Remarks
Respiratory distress syndrome	First 6 hr of life	Common in preterm neonates
Meconium aspiration syndrome	First few hr of life	Common in term, post-term and small for date babies; history of meconium stained liquor
Pneumonia	Any age	Often bacterial
Transient tachypnea of newborn	First 6 hr after birth	Tachypnea with minimal distress; lasts for 48-72 hr
Persistent pulmonary hypertension	Any age	Severe distress; cyanosis
Pneumothorax	Any age	Sudden deterioration; usually during assisted ventilation
Tracheoesophageal fistula, diaphragmatic hernia, lobar emphysema	Any age	May show associated malformations; polyhydramnios in oesophagal atresia

Non-pulmonary causes

Cardiac:

• Congestive heart failure; congenital heart disease

Metabolic:

• Hypothermia, hypoglycemia, metabolic acidosis

CNS:

• Asphyxia, cerebral oedema, haemorrhage

Chest wall:

• Asphyxiating thoracic dystrophy, Werdnig-Hoffman disease

---

Pathophysiology