History:

The babys initials are P.K. She was born at 41 Weeks+5 days via spontaneous vaginal delivery.
She weighed 3.66 KG when delivered. There was a minor complication; the baby had meconium
stained amniotic fluid, but didnt develop meconium aspiration syndrome. She just got suction
but didnt require care at the SCBU or the ICU. The baby has since passed many wet and dirty
nappies and is feeding every 2-3 hours. She is breast and formula fed because the mother feels
like she isnt taking in enough milk via breast milk alone.
The mothers initials are L.K and she is 24 years of age. She has had 3 pregnancies but 2
miscarriages; they are idiopathic in nature as no family members had similar incidents. She
experienced no illness during pregnancy and received appropriate antenatal care and went to all
her appointments in addition to taking the folate and appropriate vitamin supplements
(pregnacare). She does not and never did smoke. She drank prior to pregnancy but never during
or since giving birth. She was on no medications such as antibiotics or pain killers during her
pregnancy There were no conditions diagnosed during pregnancy; it was a healthy one.

Examination: (Respiratory exam)

Color: pink all over, no evidence of cyanosis
Respiratory status: Normal vigorous breathing
Posture: Normal semi-flexed
No obvious dysmorphisms
Weight: 3.66
Head circum: 34.5
Length: 47 cm
On general inspection, there were no obvious chest wall deformities or asymmetrical movements
of the chest. The baby was not cyanosed or jaundiced, it was pink of color, the resp rate was
normal (52 breaths/ minute). On general inspection the baby seemed comfortable; it was not
using its accessory muscles to breathe. There were no audible sounds like grunting or wheezing.
There was no nasal flaring or subcostal/intercostals recessions, and normal paradoxical
abdominal breathing was noted that was not excessively labored. On auscultation of the 2 lobes
on the left and the 3 lobes on the right, the breath sounds were present and of vesicular nature
with no wheeze or stridor.
Respiratory Distress:

List 4 signs of respiratory distress in the newborn:

Grunting
Nasal flaring
Tachypnea
Intercostals/subcostal recession

List 4 respiratory and 3 other causes of respiratory distress in the newborn:

Respiratory: Neonatal respiratory distress syndrome, transient tachypnea of the newborn,
meconium aspiration syndrome, and persistent pulmonary hypertension.

Non pulmonary: cyanotic congenital heart disease, sepsis and congenital diaphragmatic hernia

List the initial investigations you might perform on a newborn with respiratory distress:
1- Physical exam: auscultation of both the heart and the lungs
2- Vitals: Heart rate, respiratory rate, oxygen saturation, PCO2,
3- Imaging: Abdominal and chest x-ray
4- blood cultures (if indicated other cultures for sources of infections like urinary tract, CSF
or throat)