Educational draft · awaiting clinical reviewUse Rapid for revision, not patient-care decisions. Check current national and local guidance and the BNF or BNFC before acting.
2 min synopsisUK scopeSources checked 27 Aug 2026Clinical review pending
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Respiratory failure, shock or cyanosis
Apnoea, gasping, profound recession, exhaustion, bradycardia, poor perfusion or cyanosis unresponsive to oxygen requires immediate neonatal life support and senior neonatal help.
Action: Warm and position the baby, assess breathing and heart rate, apply right-hand preductal oximetry and support lung inflation and ventilation according to NLS. Check airway patency, use a blender, obtain blood gas and glucose without delaying treatment, and consider pneumothorax, congenital heart disease, diaphragmatic hernia and sepsis. Decompress a clinically tensioned pneumothorax urgently; avoid mask ventilation when congenital diaphragmatic hernia is suspected and intubate with gastric decompression.
Synopsis
Stabilise a newborn with respiratory compromise, use gestation, timing and physiology to distinguish common causes, and escalate oxygen, non-invasive support, surfactant, ventilation and cause-specific treatment safely.
Respiratory distress is tachypnoea, recession, grunting, nasal flaring, cyanosis or apnoea; rate alone does not describe severity.
Stabilise temperature, airway, breathing, circulation and glucose before pursuing a perfect diagnosis. Attach preductal saturation and use ECG when resuscitation is needed.
Gestation and onset organise the differential: preterm early distress suggests RDS; term caesarean birth suggests transient tachypnoea; meconium suggests aspiration.
Key red flags
Apnoea, gasping, falling heart rate, reduced respiratory effort or altered responsiveness signals exhaustion and need for ventilation rather than observation.
Investigation priorities
01
First-line: preductal pulse oximetry and continuous cardiorespiratory monitoringFirst stepFirst line
Quantify oxygenation and deterioration while initial support is delivered.
Management branches
ImmediateStabilise physiology
A newborn has respiratory distress or cyanosis.
Warm, position, assess breathing and heart rate and call neonatal help.
Apply preductal oximetry, support airway and breathing with blended oxygen and CPAP or ventilation as indicated.
Key medicines
Poractant alfa intratracheal surfactantInitial 100–200 mg/kg, equivalent to 1.25–2.5 mL/kg of the 80 mg/mL preparation, given endotracheopulmonarily as soon as possible after diagnosing RDS. If required, give further 100 mg/kg doses about 12 hours apart; maximum cumulative dose 300–400 mg/kg according to the SmPC and neonatal protocol.
National guidance is shown before implementation-dependent detail. Typical adult dose examples remain subject to patient factors, contraindications and the live BNF or specialist protocol. Source check completed 27 Aug 2026; clinical approval remains outstanding.