Significance of grunting respirations in infants admitted to a well-baby nursery.

OBJECTIVES: (1) To determine the frequency and duration of grunting in term and near-term newborns; (2) to determine the peripartum characteristics associated with grunting; and (3) to compare the short-term outcomes of newborns with and without grunting.

DESIGN: Medical record review of all newborns admitted to a well-baby nursery during a 2-month period.

SETTING: University well-baby nursery for term infants, with more than 2700 deliveries annually.

MAIN OUTCOME MEASURES: Frequency and duration of grunting, maternal and newborn clinical characteristics, clinical course, and length of stay.

RESULTS: Grunting respirations beginning during the first 4 hours of life were recorded for 81 (17.4%) of 466 newborns. Fifty-five (68%) stopped grunting within 30 minutes of birth, 69 (85%) by 1 hour, and 75 (93%) by 2 hours. More mothers of grunting infants received intrapartum antibiotics than mothers of nongrunters (33% vs 20%; P =.03). More grunting infants than nongrunters received bag and mask resuscitation (15% vs 5%; P =.01). More chest radiographs, blood cell counts, and blood cultures were ordered for grunting infants, and antibiotics were more often given to grunting than nongrunting infants (11.1% vs 4.6%; P =.04). Grunters' length of stay exceeded that of nongrunters (72 vs 55 hours; P =.01), but only 3 were transferred to a neonatal intensive care unit.

CONCLUSIONS: All grunting infants should be carefully observed, but because nearly all otherwise healthy term or near-term infants will stop grunting and have a benign course, other interventions can be postponed for 1 or 2 hours to give the newborn a chance to stop grunting or show other signs of respiratory illness.