A newborn girl is evaluated in the nursery for respiratory distress. Approximately 30 minutes after the patient was born, she developed sudden-onset tachypnea and hypoxia for which she is receiving supplemental oxygen by nasal cannula. The infant was born to a 35-year-old woman at 39 weeks gestation via a scheduled cesarean delivery for breech presentation. Membranes ruptured at delivery, revealing clear amniotic fluid. The mother had insulin-controlled gestational diabetes mellitus and tested positive for Group B Streptococcus at 36 weeks gestation. Apgar scores were 7 and 8 at 1 and 5 minutes, respectively. Temperature is 36.7 C (98 F). Examination shows tachypnea, grunting, nasal flaring, and subcostal and intercostal retractions. Cardiac examination reveals tachycardia without murmurs. Femoral pulses are 2+. Chest x-ray reveals a flattened diaphragm, mild cardiomegaly, and a prominent horizontal fissure on the right side. Which of the following is the most likely outcome of this patient?

Question

A newborn girl is evaluated in the nursery for respiratory distress.  Approximately 30 minutes after the patient was born, she developed sudden-onset tachypnea and hypoxia for which she is receiving supplemental oxygen by nasal cannula.  The infant was born to a 35-year-old woman at 39 weeks gestation via a scheduled cesarean delivery for breech presentation.  Membranes ruptured at delivery, revealing clear amniotic fluid.  The mother had insulin-controlled gestational diabetes mellitus and tested positive for Group B Streptococcus at 36 weeks gestation.  Apgar scores were 7 and 8 at 1 and 5 minutes, respectively.  Temperature is 36.7 C (98 F).  Examination shows tachypnea, grunting, nasal flaring, and subcostal and intercostal retractions.  Cardiac examination reveals tachycardia without murmurs.  Femoral pulses are 2+.  Chest x-ray reveals a flattened diaphragm, mild cardiomegaly, and a prominent horizontal fissure on the right side.  Which of the following is the most likely outcome of this patient?

Quizplus · Accepted Answer

Explanation: 11ec2b69_c08c_6732_8f63_7bbcee28a670_MD0005_00 This newborn has respiratory distress and imaging findings consistent with transient tachypnea of the newborn (TTN). TTN is a condition caused by retained fetal lung fluid after delivery. Patients born prematurely or by cesarean section are at increased risk, as typical resorptive mechanisms are activated at term and during labor. TTN also occurs more frequently in infants born to mothers with diabetes (as seen in this case); this is due to impaired fluid clearance in the diabetic fetal lung. TTN presents shortly after birth with tachypnea, increased work of breathing (eg, retractions, nasal flaring), and often cyanosis. However, breath sounds are usually clear on examination. Hyperinflation (ie, flattened diaphragm), mild cardiomegaly, prominent vascular markings, fluid in the interlobar fissures, and pleural effusions may be seen on chest x-ray. Treatment for TTN is supportive and includes supplemental oxygen as needed. Symptoms generally resolve spontaneously within 72 hours with no long-term complications. (Choice A) Permanent neurocognitive impairment is a severe complication of birth asphyxia due to meconium aspiration syndrome, which presents at delivery with respiratory distress from meconium-stained amniotic fluid. Meconium aspiration syndrome is unlikely in this case with clear amniotic fluid. (Choice B) Persistent wheezing and steroid dependence can occur in infants with respiratory distress syndrome who subsequently develop chronic lung disease. Respiratory distress syndrome typically affects premature infants due to deficient pulmonary surfactant, and chest x-ray has a classic ground-glass appearance with air bronchograms. (Choice C) Patients with an untreated ventricular septal defect are at risk for progressive pulmonary hypertension and heart failure; however, a holosystolic murmur, not respiratory distress, would be expected on examination. (Choice D) Recurrent lung infections and failure to thrive are characteristic of cystic fibrosis. Meconium ileus can occur in the newborn period, but respiratory symptoms typically develop over time. Educational objective: Transient tachypnea of the newborn is a common complication of cesarean deliveries resulting from retained fetal lung fluid. Chest x-ray findings include hyperinflation, cardiomegaly, and fluid in the interlobar fissures. The symptoms usually resolve spontaneously within 72 hours with no long-term complications. References: Respiratory distress in the newborn. (http://www.ncbi.nlm.nih.gov/pubmed/25274969)

A Newborn Girl Is Evaluated in the Nursery for Respiratory