During initial assessment, what is a key indicator that a neonate may have respiratory distress?

Intermittent grunting is a significant indicator that a neonate may be experiencing respiratory distress. Grunting occurs as a physiological response to help maintain lung inflation and improve oxygenation. When a neonate is struggling to breathe, they might produce a grunting sound during expiration as an effort to increase intrathoracic pressure, which can assist in keeping the alveoli open and preventing atelectasis. This sound is often a sign of increased work of breathing and can indicate that the neonate is either hypoxic or experiencing some form of respiratory compromise. Recognizing this sign early is crucial for timely intervention and treatment to prevent further deterioration of the infant's respiratory status.

In contrast, clearing of airways, increased feeding tolerance, and stable vital signs do not directly point towards respiratory distress. Each of those indicates a more stable or positive condition rather than the presence of respiratory issues.