Chart — Neonatal & Pediatric
Neonatal Respiratory Disorders Comparison
Five disorders account for most neonatal respiratory distress, and they sort out by the baby in front of you — the gestation, the delivery, and the timing. This grid lines them up by population, onset, mechanism, chest X-ray, and management.
Written by Apex Respiratory Editorial Team
Educational use only. This material supports respiratory therapy education and exam review. It is not medical advice and is not a substitute for clinical judgment, institutional protocols, or physician orders. Always follow facility policies and current provider orders, and verify calculations independently before clinical use.
The Five Disorders Compared
| Disorder | Typical Infant | Onset / Course | Mechanism | Chest X-Ray | Management |
|---|---|---|---|---|---|
| RDS (surfactant deficiency) | Premature (under ~34-37 wk) | Within hours, peaks 48-72 h | Surfactant deficiency causing diffuse atelectasis | Diffuse ground-glass, air bronchograms, low volumes | Antenatal steroids, early CPAP, surfactant |
| Transient tachypnea (TTN) | Term or late-preterm, cesarean without labor | Onset at birth, resolves in 24-72 h | Delayed clearance of fetal lung fluid | Hyperinflation, perihilar streaking, fluid in the fissures | Supportive oxygen or CPAP; self-limited |
| Meconium aspiration (MAS) | Term or post-term, meconium-stained fluid | At or shortly after birth | Airway obstruction, chemical pneumonitis, surfactant inactivation, ball-valve air trapping; risk of PPHN | Patchy infiltrates, hyperinflation, possible pneumothorax | Resuscitation, oxygen/ventilation, surfactant, iNO for PPHN; do not routinely intubate to suction a vigorous infant |
| Persistent pulmonary hypertension (PPHN) | Term or post-term (often with MAS, sepsis, or asphyxia) | First hours of life | Pulmonary vascular resistance fails to fall, causing right-to-left shunting (through the PFO/PDA) | May be clear or show the underlying disease; pre/post-ductal SpO₂ split | Optimize oxygenation and ventilation, inhaled nitric oxide, sometimes ECMO |
| Bronchopulmonary dysplasia (BPD) | Premature, after prolonged oxygen/ventilation | Evolves over weeks (oxygen need at 36 wk postmenstrual age) | Arrested alveolar development plus oxygen and baro/volutrauma injury | Hyperinflation with cystic or streaky changes | Gentle ventilation, oxygen targeting, nutrition, diuretics/bronchodilators per protocol; prevention is key |
How to Use This Chart
Start with the baby, not the film. The gestation, the delivery, and the timing of distress narrow the differential before the chest X-ray confirms it — and remember these disorders overlap, so one infant can carry more than one.
- Prematurity points to RDS or BPD; a term baby delivered by cesarean with quick resolution suggests TTN; meconium-stained fluid in a post-term baby suggests MAS; differential cyanosis with a pre/post-ductal SpO₂ split suggests PPHN.
- A preductal (right hand) versus postductal (foot) SpO₂ difference greater than about 5–10% suggests right-to-left ductal shunting (PPHN).
- These overlap: meconium aspiration can cause PPHN, and the oxygen and ventilation used for RDS can lead to BPD.
Related Resources
Sources
- Kacmarek RM, Stoller JK, Heuer AJ. Egan's Fundamentals of Respiratory Care. 12th ed. Elsevier; 2021. Neonatal respiratory disorders chapters.
- Sweet DG, Carnielli VP, Greisen G, et al. European Consensus Guidelines on the Management of Respiratory Distress Syndrome: 2022 Update. Neonatology. 2023;120(1):3-23.