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. Inspiratory stridor is correct. Stridor is a high-pitched, noisy sound during inspiration caused by partial obstruction of the upper airway, such as laryngeal edema or congenital anomalies. In a newborn, stridor indicates that the infant is struggling to get enough air into the lungs, and immediate assessment is needed to prevent hypoxia. B. Increased appetite is incorrect. Feeding difficulties, not increased appetite, are more likely in a newborn experiencing respiratory distress. Labored breathing can make sucking and swallowing difficult, which may lead to poor intake or fatigue during feeding. C. Retractions are correct. Retractions occur when the intercostal muscles, subcostal areas, or suprasternal notch pull inward with inspiration. This reflects increased respiratory effort because the newborn is working harder to expand the lungs against resistance. Retractions are a classic and easily observable sign of respiratory distress. D. Nasal flaring is correct. Flaring of the nostrils occurs as the infant attempts to increase airflow into the lungs. This is a compensatory mechanism to reduce airway resistance and improve oxygen intake. Nasal flaring is particularly noticeable in newborns because their nasal passages are narrow and easily obstructed. E. Grunting is correct. Grunting is an expiratory sound made when the newborn partially closes the glottis while exhaling. This helps maintain alveolar pressure and improve gas exchange, which is a compensatory response to lung immaturity or alveolar collapse. Persistent grunting is a red flag for significant respiratory compromise.