A 1-Hour-Old Girl Is Evaluated in the Nursery for Respiratory

question 629

Multiple Choice

A 1-hour-old girl is evaluated in the nursery for respiratory distress.  Her mother had an uncomplicated pregnancy.  At 38 weeks gestation, the mother had rupture of membranes with clear fluid.  Two hours later during induction of labor, nonreassuring fetal heart abnormalities were noted, and an emergency cesarean delivery was performed.  Temperature is 37.2 C (99 F) .  Pulse oximetry is 95% on 1 L oxygen via nasal cannula.  Pulmonary examination reveals tachypnea, nasal flaring, intercostal retractions, and clear breath sounds.  Cardiac examination shows tachycardia with normal heart sounds; femoral pulses are 2+ bilaterally.  The abdomen is soft with no hepatosplenomegaly.  Complete blood count is normal, and blood culture is pending.  Chest x-ray reveals increased lung volumes and fluid in the interlobar fissures.  Which of the following is the most likely etiology of this patient's symptoms?

• A)Aspiration of infected amniotic fluid
• B)Bronchiolar obstruction from thickened mucus
• C)Chemical irritation and airway obstruction
• D)Delayed resorption and clearance of pulmonary fluid
• E)Equalization of intrapleural and extrapleural pressures
• F)Underdeveloped lungs with surfactant deficiency

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