Several authors have reported that grunting in older infants and children can be an indication of severe disease. These other causes were most often illnesses that were accompanied by high fever or appeared to cause pain.
These studies support an association of grunting with serious illness in older infants but may not be applicable to newborns with grunting respirations. The idea for our study arose from a question posed during a morbidity and mortality conference where the death of a term newborn nursery infant who had several hours of documented grunting respirations was being discussed.
The question, "How long should a general pediatrician in a well-baby nursery observe a newborn term or near-term infant with grunting respirations before intervening? Although this study does not provide a direct answer to this question, it provides some insight into the frequency and natural course of grunting respirations in term infants admitted to a well-baby nursery. The second hypothesis was that most infants who grunted would have a good outcome.
Although more laboratory tests were ordered for grunting infants, more grunting infants received antibiotics, and they remained in the hospital longer, only 3 were believed by their physicians to be ill enough to require transfer to the NICU. Two did well, but 1 of these infants developed persistent fetal circulation and had a prolonged NICU course. Our study has some important limitations. First, data collection was retrospective and based on the assessments and charting accuracy of the nursing staff.
Many nurses were working in the nursery, and they may have varied in their categorization or charting of grunting or other symptoms. We believe, however, that if grunting was not recorded, it would be more likely to have been in infants in whom grunting was brief and who had a good outcome; thus, our study could have underestimated the incidence of grunting while overestimating the number of adverse outcomes.
Second, adverse outcomes in this population of term and near-term infants were very infrequent; thus, our study does not have sufficient power to make reliable determinations of sensitivity, specificity, or predictive values regarding grunting and its association with serious illness. Despite these limitations, we believe that our study can help inform decision making in a well-baby nursery when an infant is noted to exhibit grunting during transition.
Careful observation of grunting infants, particularly for other evidence of respiratory problems, is warranted, but other interventions can be postponed for 1 or 2 hours to give the grunting a chance to resolve. If grunting persists, or the child's condition deteriorates during this period, further investigations for treatable causes of grunting, eg, sepsis, should be undertaken. Corresponding author and reprints: Karen F. Arch Pediatr Adolesc Med.
Coronavirus Resource Center. Our website uses cookies to enhance your experience. By continuing to use our site, or clicking "Continue," you are agreeing to our Cookie Policy Continue. Save Preferences. Privacy Policy Terms of Use. Twitter Facebook. This Issue. Citations 5. View Metrics. March Gentry C. Yost, MD ; Paul C. Young, MD ; Karen F. Buchi, MD. Subjects and methods. Incidence and duration of grunting respirations.
View Large Download. Associated maternal characteristics. Grunting Respirations and Maternal Characteristics. Associated infant characteristics. Grunting Respirations and Infant Characteristics. Physician treatment and short-term outcomes. Short-term vs prolonged grunting. Silverman WAAndersen DH A controlled clinical trial of effects of water mist on obstructive respiratory signs, death rate and necropsy findings among premature infants.
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Medically reviewed by Karen Gill, M. Causes Treatments When to seek help Takeaway Is it normal? The cause of newborn grunting. The remedies. When to be concerned. Other signs of respiratory problems include: blue tongue or skin weight loss fever lethargy nasal flaring pauses in breathing.
The takeaway. And treat grunting with every breath as a medical emergency.
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