In a prospective randomized trial, 103 term newborns with persisting dyspnea, tachypnea and/or cyanosis were treated in the delivery room with oxygen for 5-10 min and then with oxygen plus mask CPAP for another 5-15 min. Cases with overt prenatal or intrapartum obstetric pathology were excluded from the study. 41/103 infants (40%) responded to this procedure within 10-25 min. The remaining 62 infants (60%) were randomly allocated to one of 3 forms of further treatment: continuation of mask CPAP for 20 min (group A, n=24), volume expansion with 9 mL of 3 mL albumin, 3 mL glucose, and 3 mEq NaHCO3 (group B, n=24), or volume expansion with 4.5 mL albumin and 4.5 mL glucose (group C, n=14). There was no statistical difference in birth weight, gestational age, or Apgar scores at 1 and 5 min between groups.

Time to normalization of symptoms in the 62 infants (respiratory rate<50, no retractions, grunting, or nasal flaring) was significantly shorter in the volume expansion groups (B: 45±41 min, range 20-180, and C: 80±72 min, range 20-210) than in the mask CPAP group (A: 224±256 min, range 30-1200, p=0.02). 34/62 randomized infants did not respond and were admitted to the special care unit for further evaluation (group A: 21/24, group B: 7/24, group C: 6/14). 23 of these had no abnormal findings, 8 had radiological signs of transient tachypnea, and one had a non-tension pneumothorax. Septicemia was diagnosed in 2 infants. No infant was intubated, and all 103 infants were well at discharge. These results suggest that incremental application of simple primary care procedures, including volume expansion (± alkali) in term newborns with persistent postnatal dyspnea avoids over treatment and unnecessary maternal separation and reliably selects infants who need special care.