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Nursing QUESTION #9131
Question 1
A neonate born at 36 weeks gestation has respiratory rate of 72/min, subcostal retractions, nasal flaring, and grunting. Chest X-ray shows a 'ground glass appearance' with air bronchograms. The MOST likely diagnosis and PRIMARY pathophysiology is:
  • Meconium Aspiration Syndrome due to hypoxia-induced meconium passage
  • Respiratory Distress Syndrome (RDS) due to surfactant deficiency✔️
  • Transient Tachypnea of Newborn (TTN) due to retained lung fluid
  • Pneumonia due to Group B Streptococcal infection
Correct Answer Explanation

This is a classic presentation of Neonatal Respiratory Distress Syndrome (RDS), also called Hyaline Membrane Disease:

  • Prematurity (36 weeks — late preterm)
  • Grunting, retractions, nasal flaring, tachypnea
  • Ground glass appearance + air bronchograms on CXR = pathognomonic of RDS

Pathophysiology: Deficiency of surfactant (produced by Type II pneumocytes from ~24 weeks, mature by ~35 weeks). Surfactant reduces alveolar surface tension. Without it:

\[\text{Surface tension} \uparrow \Rightarrow \text{Alveolar collapse} \Rightarrow \text{V/Q mismatch} \Rightarrow \text{Hypoxia}\]

  • Treatment: Exogenous surfactant (beractant, poractant alfa) via endotracheal tube + respiratory support (CPAP/mechanical ventilation)
  • Prevention: Antenatal corticosteroids (betamethasone 12 mg IM × 2 doses, 24 hrs apart) if delivery expected before 34 weeks — accelerates fetal lung maturity