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?:definition
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Level 2 Neonatal Respiratory Distress is defined by four criteria: first, the newborn must be between 0 and 28 days of life; second, an abnormal respiratory rate (not measured, but reported as \'rapid breathing\', \'slow breathing\', having periods of \'no breathing\', or \'abnormal breathing\'); third, the presence of any one of the following five clinical symptoms that indicate labored breathing: a) Nasal flaring (dilatation of alae nasi); b) Noisy respirations in the form of expiratory grunting, stridor, or wheeze; c) Retractions or increased chest indrawings on inspiration (subcostal, intercostal, sternal, suprasternal notch) or seesaw respirations; d) Central cyanosis (whole body, including lips and tongue) on room air; e) Low Apgar score (less than 7 points) at 10 minutes with a respiration score less than 2; fourth, one of the following two requirements: a) No medical record documentation, but reporting through either a non-medical observer (e.g., mother, father, community worker) or via standard census mechanisms (e.g., Demographic and Health Surveillance System), or b) Collection of information from medical review or billing codes.
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