The respiratory rate ranges between 30 and 60 breaths per minute in infants. For premature infants it is higher and fluctuates more widely. Because fluctuations are rapid, the respiratory rate should be counted for a full minute with the infant in full resting state, preferably asleep. A rate consistently over 60 breaths per minute during periods of regular breathing should be evaluated further.
Since the breathing of newborn infants is almost entirely diaphragmatic, the soft front of the thorax usually is drawn inward during inspiration, while the abdomen protrudes. In a quiet infant, this paradoxical pattern has no clinical significance, but when it changes to predominantly thoracic breathing, intraabdominal or intrathoracic pathology should be suspected. On the other hand, an increase in abdominal breathing suggests pulmonary disease.
Newborn infants, especially those born prematurely, may exhibit periodic breathing, characterized by alternating periods of breathing at a normal rate and periods of a markedly slow rate of respiration, which may cease three or more times for 3 s or longer. Such alternating respiratory patterns have been observed in 30 to 95 percent of premature babies during sleep, but less frequently in term infants. Periods of apnea greater than 20 s or accompanied by bradycardia or cyanosis should be evaluated.5,6
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