A preterm newborn of 36 weeks of gestation is admitted to the NICU. Approximately 2 hours after birth, the newborn begins having difficulty breathing, with grunting, tachypnea, and nasal flaring. Which is important for the nurse to recognize?

A) This is a normal finding.
B) This is not significant unless cyanosis is present.
C) Improvement should occur within 24 hours.
D) Further evaluation is needed.

Difficulty breathing, with grunting, tachypnea, and nasal flaring are clinical manifestations of respiratory distress syndrome and require further evaluation. This is not a normal finding and requires further evaluation. Cyanosis may be present, but these are significant findings indicative of respiratory distress without cyanosis. The child's condition will most likely worsen for approximately 48 hours without intervention. Improvement may begin at 72 hours.