Which assessment finding would most likely indicate respiratory distress in a neonate?

Respiratory distress in a neonate can manifest through a variety of physical signs, and the presence of retractions and grunting is a strong indicator of such distress. Retractions refer to the inward movement of the chest wall during inhalation, which occurs when the infant is struggling to breathe effectively due to obstructed or compromised airflow. This sign reveals that the body is making an increased effort to draw air into the lungs.

Grunting is an audible sound made as the neonate attempts to exhale against a closed glottis, which helps increase intrathoracic pressure and improve oxygenation. The combination of these two findings – retractions and grunting – suggests that the infant is working hard to breathe, indicating respiratory distress that requires immediate attention.

In contrast, a decreased heart rate might indicate bradycardia, which is not a specific sign of respiratory distress. A weak cry can hint at overall weakness or lethargy rather than specifically pointing to breathing difficulties. Increased alertness is generally a positive sign and does not correlate with respiratory distress; in fact, a distressed neonate often appears lethargic.