Key pointsRespiratory distress is a common presenting feature among newborn infants.Prompt investigation to ascertain the underlying diagnosis and appropriate subsequent management is important to improve outcomes.Many of the underlying causes of respiratory distress in a newborn are unique to this age group.A chest radiograph is crucial to assist in diagnosis of an underlying cause.Educational aimsTo inform readers of the common respiratory problems encountered in neonatology and the evidence-based management of these conditions.To enable readers to develop a framework for diagnosis of an infant with respiratory distress.The first hours and days of life are of crucial importance for the newborn infant as the infant adapts to the extra-uterine environment. The newborn infant is vulnerable to a range of respiratory diseases, many unique to this period of early life as the developing fluid-filled fetal lungs adapt to the extrauterine environment. The clinical signs of respiratory distress are important to recognise and further investigate, to identify the underlying cause. The epidemiology, diagnostic features and management of common neonatal respiratory conditions are covered in this review article aimed at all healthcare professionals who come into contact with newborn infants.

Key Points Question Can inhaled corticosteroids (ICS) alone or in combination with long-acting β 2 agonists (LABA) improve percent predicted forced expiratory volume in 1 second compared with placebo? Findings In a randomized clinical trial evaluating 53 preterm-born children, although ICS treatment for 12 weeks improved percent predicted forced expiratory volume in 1 second by 7.7%, the improvement after use of the combination of ICS/LABA was significantly greater at 14.1% compared with the placebo group. Active treatment decreased fractional exhaled nitric oxide and improved postexercise bronchodilator response but did not improve exercise capacity. Meaning This trial suggests that combined ICS/LABA treatment is beneficial for prematurity-associated lung disease in preterm-born children.

IntroductionAlthough bronchopulmonary dysplasia (BPD) is associated with lung function deficits in childhood, many who develop BPD have normal lung function in childhood, and many without BPD including those born at 33–34 weeks’ gestation, have lung dysfunction in childhood. Since the predictability of BPD for future lung deficits is increasingly doubted, we prospectively recruited preterm-born children to identify early life factors which are associated with lung function deficits after preterm-birth.MethodsFrom 767 children aged 7–12 years, who had their respiratory symptoms assessed, and had spirometry before and after a bronchodilator in our Respiratory Health Outcomes in Neonates (RHiNO) study, 739 (544 preterm-born at ≤34 weeks’ gestation and 195 term-born) had satisfactory lung function. Data were analysed using multivariable logistic regression and mediation.ResultsWhen preterm-born children were classified according to their lung function, low lung function (prematurity-associated lung disease, PLD) was associated with BPD, gestation and intrauterine growth restriction on univariable logistic regression analyses. However, on multivariable logistic regression analyses, gestation (Beta=−0.153, se: 0.051, p=0.003) and intrauterine growth restriction (odds ratio 1.783, 95% confidence interval: 1.06, 3.00, p=0.029) remained significantly associated with later deficits of lung function but BPD (0.99; 0.52, 1.89, p=0.974) did not. Mediation analyses confirmed these results.ConclusionsAlthough traditionally BPD has been associated with low lung function in later life, these data show that gestation and IUGR are significantly associated with PLD in childhood but BPD is not. By identifying children with PLD, we can better understand the underlying mechanisms and develop optimal therapies.

Introduction: Preterm-born children have their normal in-utero lung development interrupted, thus are at risk of short-and long-term lung disease. Spirometry and exercise capacity impairments have been regularly reported in preterm-born children especially those who developed chronic lung disease of prematurity (CLD) in infancy.However, specific phenotypes may be differentially associated with exercise capacity. We investigated exercise capacity associated with prematurityassociated obstructive (POLD) or prematurity-associated preserved ratio of impaired spirometry (pPRISm) when compared to preterm-and term-controls with normal lung function. Materials and Methods: Preterm-and term-born children identified through home screening underwent in-depth lung function and cardiorespiratory exercise testing, including administration of postexercise bronchodilator, as part of the Respiratory Health Outcomes in Neonates (RHiNO) study.Results: From 241 invited children, aged 7-12 years, 202 underwent exercise testing including 18 children with POLD (percent predicted (%)FEV 1 and FEV 1 / FVC < LLN); 12 pPRISm (%FEV 1 < LLN and FEV 1 /FVC ≥ LLN), 106 preterm-controls (PT c , %FEV 1 ≥ LLN) and 66 term-controls (T c , %FEV 1 > 90%). POLD children had reduced relative workload, peak O 2 uptake, CO 2 production, and minute ventilation compared to T c , and used a greater proportion of their breathing reserve compared to both control groups. pPRISm and PT c children also had lower O 2 uptake compared to T c . POLD children had the greatest response to postexercise bronchodilator, improving their %FEV 1 by 19.4% (vs 6.3%, 6% 6.3% in pPRISm PT c, T c , respectively; p < .001). Conclusion:Preterm-born children with obstructive airway disease had the greatest impairment in exercise capacity, and significantly greater response to postexercise bronchodilators. These classifications can be used to guide treatment in children with POLD.