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Neonatal respiratory distress syndrome — RACP Paediatrics MCQ

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ModerateNeonatologyNeonatal respiratory distress syndromeRACP Paediatrics

A male infant is born at 28 weeks after spontaneous preterm labour. Within minutes he has grunting, subcostal recession and an oxygen requirement; chest radiograph shows low lung volumes with diffuse reticulogranular change and air bronchograms. What is the most likely cause?

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Correct answer: C — Surfactant deficiency due to immaturity of type II pneumocytes

Respiratory distress syndrome in a very preterm infant is caused by inadequate surfactant production from immature type II pneumocytes, causing atelectasis and poor compliance. Transient tachypnoea usually occurs in term or near-term infants and gives hyperinflation rather than low-volume granular lungs. The key examination cue is that prematurity plus early respiratory distress and classic radiology should prompt CPAP and consideration of surfactant.

Reference: RCH Clinical Practice Guidelines: Neonatal respiratory distress; Therapeutic Guidelines (eTG)