The nurse is assessing a newborn who is 12 hours old. Which symptoms would indicate the newborn is experiencing respiratory distress?(Select all that apply)

A. Grunting is an expiratory sound produced when a newborn partially closes the glottis during exhalation. This helps maintain positive airway pressure, keeps alveoli open, and improves oxygenation. Persistent grunting indicates the newborn is working hard to breathe and is a classic early sign of respiratory distress. B. Increased appetite is not a symptom of respiratory distress. In fact, newborns experiencing distress often have difficulty feeding or show poor coordination of sucking and swallowing because breathing requires increased effort. Feeding difficulties, rather than increased appetite, may accompany respiratory compromise. C. Stridor is a high-pitched sound heard during inspiration, typically caused by upper airway obstruction. It may result from conditions such as laryngomalacia, vocal cord paralysis, or airway edema. Stridor is a red flag for respiratory compromise and requires prompt assessment and monitoring. D. Retractions occur when a newborn uses accessory muscles to breathe, pulling the skin inward around the sternum, ribs, or clavicles. This indicates increased work of breathing and reduced lung compliance. Retractions are a reliable physical sign of significant respiratory distress. E. Nasal flaring occurs when the nostrils widen during inspiration to increase airflow. It is one of the earliest visible signs of respiratory distress and signals that the newborn is compensating for hypoxia or increased airway resistance.