Newborn Gasping For Air: Is This Normal?

It is common for newborns to gasp for air when they cry for long periods or during feeding. This is because they are unable to breathe and eat simultaneously, so they hold their breath while eating and then gasp for air. Newborns also tend to have mucus blocking their small airway passages, which can cause them to gasp for air. In addition, newborns' lungs are initially filled with fluid, so the sudden change of environment following birth will force them to breathe in air that may sound like a gasp. However, if gasping for air persists, it could be a sign of an underlying medical condition.

Transient Tachypnea of the Newborn (TTN)

The condition presents within the first few minutes to hours after birth, with physical exam findings usually including signs of respiratory distress such as tachypnea (respiratory rate greater than 60 per minute), intercostal/subcostal/suprasternal retractions, crackles, and diminished or normal breath sounds on auscultation. The duration of respiratory distress is the principal determinant for the diagnosis of TTN. If the distress resolves within the first few hours of birth, it can be labelled as "delayed transition". However, if tachypnea lasts over 6 hours, further workup is required to rule out other causes of respiratory distress.

Treatment for TTN is typically supportive, as it is a self-limited condition. Oxygen support may be provided if pulse oximetry or arterial blood gas analysis suggests hypoxemia. Antibiotics may also be given empirically until infection is ruled out. In rare cases, babies with TTN may have persistent lung problems for up to one week. However, overall prognosis is excellent, with most symptoms resolving within 48 hours of onset.

Respiratory Distress Syndrome (RDS)

Risk Factors

Risk factors for RDS include:

• Premature birth
• Family history of RDS
• Multiple births
• C-section delivery
• Maternal diabetes
• Underweight baby
• Sickness at the time of delivery
• Cold, stress, or hypothermia

Symptoms

Symptoms of RDS include:

• Fast and shallow breathing
• Grunting sound with each breath
• Bluish skin and lips
• Flaring nostrils with each breath
• Chest retractions (skin over the breastbone and ribs pulls in during breathing)

Diagnosis and Treatment

RDS is typically diagnosed through a physical examination, chest X-rays, and blood tests. Treatment focuses on providing breathing support and may include:

• Nasal cannula or continuous positive airway pressure (CPAP) to deliver extra oxygen
• Surfactant replacement therapy
• Mechanical ventilation in severe cases
• Fluids and nutrients

Prognosis and Complications

Most newborns with RDS survive, but they may require extra medical care after leaving the hospital. Complications can include the development of bronchopulmonary dysplasia, a lung condition characterised by rapid and shallow breathing. Other potential complications include bleeding in the brain and lungs, infections, and pneumothorax (air leaking from the lungs into the chest cavity).

Laryngomalacia

Symptoms

The primary symptom of laryngomalacia is noisy breathing, known as stridor. This is a wheezing or high-pitched sound that a baby makes when inhaling. It is often worse when the baby is on their back, as the floppy tissues can more easily fall over the airway opening in this position. Other symptoms may include:

• Choking while feeding
• Apnea (pauses in breathing)
• Pulling in the neck and chest with each breath
• Cyanosis (blue spells)
• Gastroesophageal reflux (spitting, vomiting, and regurgitation)
• Inhalation of food into the lungs (aspiration)

Causes

The exact cause of laryngomalacia is unknown, but it is believed to be present at birth or appears within the first month of life. A lack of proper muscle tone in the upper airway may contribute to the condition. Gastroesophageal reflux (GERD) may also worsen the symptoms.

Diagnosis and Treatment

Most cases of laryngomalacia resolve without treatment by the time a child is around 18 to 20 months old. Severe cases may require surgery, known as supraglottoplasty, to cut the folds of tissue and open the airway. Medications may also be prescribed to control associated symptoms like acid reflux.

Gastroesophageal Reflux Disease (GERD)

GERD is caused by an underdeveloped lower oesophageal sphincter (LES), which acts as a barrier between the oesophagus and the airway. In babies under two years old, the LES may not fully close or may relax too often, resulting in a backflow of acidic oesophageal contents into the airway.

Signs and symptoms of GERD include throwing up or spitting up after feeding, gagging during feeding, coughing, arching of the body during feeding, and sometimes having trouble breathing. Other symptoms include frequent hiccups or belching, stomach pain, and loss of appetite.

If you suspect your baby has GERD, it is recommended to hold them upright for 30 minutes or more right after feeding. If bottle-fed, ensure the nipple part is filled with milk to prevent your baby from swallowing too much air. It is also important to burp your baby after feeding and refrain from giving them too much citrus or acidic foods.

If your baby exhibits any red flags, such as not gaining weight, developing a fever, loss of appetite, vomiting blood, coughing, wheezing, or difficulty breathing, seek medical attention immediately. Frequent reflux occurrences can lead to serious complications such as aspiration pneumonia, oesophageal ulcers, and oesophageal infection.

While GERD usually resolves around 12 months of age, it is important to consult a healthcare professional if you have any concerns or if your baby's symptoms persist or worsen.

Sleep apnea

Symptoms of sleep apnea in infants include prolonged pauses in breathing (lasting 20 seconds or longer), repeated patterns of shorter pauses, low oxygen levels, a slow heartbeat (bradycardia), and disturbed, restless sleep. If you suspect your baby may have sleep apnea, it is important to consult a healthcare professional. The only way to properly diagnose sleep apnea is through an overnight sleep study in a sleep lab, where sensors monitor your baby's brain waves, eye movements, breathing, heart rate, and oxygen levels.

Treatment for sleep apnea depends on its severity and type. Some cases may require surgery, while others may be managed with oxygen support or a continuous positive airway pressure (CPAP) machine. In rare cases, a tracheostomy may be necessary. Most babies outgrow sleep apnea as their upper airways develop and their central nervous systems mature.

Frequently asked questions