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Air leak
3%
10/291
Aspiration of meconium in the amniotic fluid
Cyanotic congenital heart disease
13%
38/291
Delayed resorption of fetal lung fluid
8/291
Surfactant deficiency
70%
203/291
Select Answer to see Preferred Response
This patient's symptoms of acute respiratory distress shortly after birth in a preterm newborn, along with a ground-glass appearing chest radiograph is strongly suggestive of respiratory distress syndrome (RDS) in the newborn, which is caused by surfactant deficiency. Type II pneumocytes synthesize surfactant at around 20 weeks gestation and at 35 weeks gestation mature levels are achieved. The surfactant is composed of fats and proteins (mostly comprised of dipalmitoylphosphatidylcholine) and has hydrophobic and hydrophilic regions. Alveoli have a tendency to collapse due to an increased surface tension, especially during expiration. Surfactant decreases alveolar surface tension, which increases lung compliance, allowing the lungs to easily expand. Figure A demonstrates a ground-glass appearing chest radiograph seen in RDS in the newborn. Incorrect Answers: Answer 1: Air leak can be seen in a pneumothorax, which is not seen in this patient's chest radiograph. Answer 2: Aspiration of meconium in the amniotic fluid describes meconium aspiration syndrome. There is no evidence of meconium-stained amniotic fluid and characteristic radiographic findings (patchy infiltrates with flattening of the diaphragm and increased anterior-posterior diameter) are not seen in this patient. Answer 3: Cyanotic congenital heart disease typically presents with a relatively milder respiratory disease. This patient's radiograph is more supportive of RDS in the newborn. Answer 4: Delayed resorption of fetal lung fluid describes transient tachypnea of the newborn, which is typically seen in later pre-term or term infants. Radiography typically demonstrates diaphragm flattening and prominent perihilar vascular markings (in a sunburst pattern). Fluid can be seen in pulmonary interlobar fissures. Bullet Summary: Respiratory distress syndrome of the newborn is caused by surfactant deficiency, which is normally involved in decreasing alveolar surface tension in order to prevent alveolar collapse and improve lung compliance.
4.7
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