Persistent grunting respirations after birth

Gustavo M Rocha, Filipa S Flor-De-Lima, Hercília A Guimaraes
Minerva Pediatrica 2018, 70 (3): 217-224

BACKGROUND: Grunting respirations occurring in the first hours of life is a frequent nonspecific clinical sign. Our objective was to assess the clinical significance of grunting lasting over two hours of birth in term and near term newborns.

METHODS: A five years retrospective study of all newborns ≥35+0 weeks of gestational age admitted for grunting to a level III Neonatal Intensive Care Unit (NICU).

RESULTS: Prolonged grunting occurred in 1.2% of the delivered newborns. Data on 151 grunter newborns and 302 controls were reviewed. Higher mother's age, pregnancy complications, lower gestational age, male gender, resuscitation need at birth, respiratory signs and therapy were associated to prolonged grunting. Poor adaptation to extrauterine life was the most frequent cause of grunting occurring in 73 (48.3%) of the cases, followed by transient tachypnea of the newborn (40 cases, 26.5%); RDS (7 cases, 4.6%) and infection (sepsis and pneumonia, 7 cases, 4.6%). Less common causes were: birth trauma (4 cases, 2.6%); pneumomediastinum (4 cases, 2.6%); hypoxic-ischemic encephalopathy (2 cases, 1.3%); polycythemia (1 case, 0.6%); anemia (1 case; 0.6%); meconium aspiration (1 case, 0.6%); congenital heart defect (1 case, 0.6%); congenital diaphragmatic hernia (1 case; 0.6%); malformation of the nose (1 case;0.6%); and immature teratoma of the thymus (1 case, 0.6%). Complications occurred in two patients (pneumothorax=1; pneumomediastinum=1). No mortality was observed. NICU stay was 5 days (1-23) CONCLUSIONS: Although persistent grunting respirations after birth follow a benign course in the majority, all affected term and near term newborns should be carefully observed and treated.

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