Diagnosing and managing neonatal respiratory depression

There are four types of neonatal respiratory depression. Most infants who require resuscitation have clearly depressed respiration at birth. The onset is prenatal in these cases. However, other infants appear normal at birth, cough and breathe a few times, but become acutely depressed in the first minute or so. A third group deteriorates gradually over the first few minutes, making little or no effort to breathe. A fourth group appears normal or fairly normal at birth, and while breathing strenuously develops signs of asphyxia. The pre- and postnatal signs, causes and differential diagnosis of the four types of neonatal depression are described, and guidelines for resuscitation are provided.