Some babies need help breathing at birth, a condition known as perinatal asphyxia, which requires emergency treatment. Any liquids blocking the baby's airway are removed, and the infant is supplied with oxygen. In most cases, the initial gasp of oxygen is enough to initiate breathing. Sometimes a trachéal tube and/or artificial respiration are necessary. Asphyxia in newborns has been linked to low birth weight, late deliveries, and flattening or twisting of the umbilical cord during labor. An infant's risk of asphyxia is lower today than in the past thanks to medical advances that help physicians identify babies at risk for asphyxia before birth, enabling doctors to take precautions before or shortly after the baby is born. If the infant starts breathing within the first five minutes, lasting damage can be averted. In some cases where an infant is known to be at risk for asphyxia, an emergency delivery may be attempted either by forceps or cesarean section.
Newborns not suffering from asphyxia may still undergo acute respiratory distress from various causes. The most widespread is hyaline membrane disease, also known as Respiratory Distress Syndrome (RDS). Usually found in premature babies, it is caused by a lack of surfactant lining in the lungs, preventing the alveoli from functioning normally. At one time this condition was a leading cause of mortality in newborns, accounting for over 25,000 infant deaths per year. Advances in neonatal care since 1970 have increased the chances of survival from about 30% to over 75%. With the current treatment, which involves administering oxygen and intravenous fluids and using a breathing machine when necessary, the infant's condition usually improves dramatically within days. Another cause of respiratory distress in newborns is fetal lung fluid that is not properly absorbed at birth. Oxygen may need to be administered, but the fluid is usually absorbed within 24 hours. Meconium aspiration poses yet another danger for newborns. Meconium, the contents of the intestines before birth, can be aspirated at birth if it is expelled into the amniotic fluid, obstructing the infant's airway and threatening to cut off respiration. Meconium aspiration accounts for between 1 and 2% of all newborn deaths.
Several congenital defects can impair breathing, including tracheomalacia, in which the structures that support the airways are underdeveloped, causing them to narrow and become blocked; trachéal stenosis, a narrowing of the trachea itself due to cartilage, malformed arteries, cysts, and other causes; and disorders of the alveoli and their blood cells. Other congenital obstructions include choanal atresia, which obstructs the airway at the back of the nose, and obstructions of the larynx (voice box). In addition to obstructive disorders, infants sometimes suffer from problems with the central nervous system mechanism that controls breathing. Infants with apnea periodically stop breathing, a condition that can be triggered by an infection, a metabolic or cardiovascular disorder, maternal drug use, or a variety of other causes. Some cases of apnea, which is especially common in premature babies, resolve on their own. A related
disorder is Sudden Infant Death Syndrome (SIDS), also known as crib death, in which an infant dies suddenly for no known reason. In most cases, an apparently healthy child is put to bed at night and found dead in the morning. Occurring in infants between the ages of one week and 12 months, SIDS claims 7,000 infants in the United States every year. While the cause of SIDS is not known, it is often classified as a respiratory disorder because the infant apparently stops breathing. Many cases occur in infants with mild colds or infections, and low birth weight and maternal smoking are known to be risk factors. In recent years, a connection has been found between SIDS and soft bedding that may trap carbon dioxide near the baby's face. There also appears to be a correlation between SIDS and babies who sleep on their stomachs. For this reason, the American Academy of Pediatrics now recommends that infants be put to sleep on their backs or sides.
Other respiratory disorders that can affect newborns include pulmonary edema (buildup of fluid in the lungs); neonatal pneumonia (usually caused by inhaling streptocuccus bacteria at birth); pulmonary hemorrhage (internal bleeding that fills a large part of the lung); congenital diaphragmatic hernias (in which the intestines protrude into the chest of the fetus, interfering with lung development); and obstruction caused by cardiovascular abnormalities.