2- Case Presentation
A male infant was delivered at 32 weeks completed gestation at a level 2
rural neonatal intensive care unit (NICU) center via emergency cesarean
section due to fetal heart rate abnormalities. Maternal serologies and
antenatal ultrasounds were unremarkable. One dose of betamethasone was
given before delivery. Apgar scores at birth were 5, 6 and 9 at 1, 5 and
10 minutes. His birth weight was 2108g. He was admitted to the NICU for
Continuous Positive Airway Pressure (CPAP) respiratory support and
ongoing care related to prematurity. He appeared non-dysmorphic and
appropriately developed for his gestation age with an unremarkable
physical examination. A partial septic work up (PSWU) was completed at
birth and antibiotics were given for 4 days then discontinued based on
negative cultures and lack of infectious symptoms. An initial X-ray at
birth for umbilical venous catheter (UVC) line placement showed mild
bilateral hazy opacities and no consolidation within the lungs (Figure
1). He was gradually weaned from CPAP to room air by day 5 of life. He
tolerated feeds well. By day 12 of life, tachycardia and tachypnea
requiring respiratory support recurred. His chest X-ray showed an
elevated left hemidiaphragm and worsening bilateral lower hazy opacities
with an area of lucency in the lower left hemithorax (Figure 2). A PSWU
was completed with a normal white cell count, low C-reactive protein
(CRP) and a negative blood culture and respiratory pathogens panel
(RPP).
Figure 1: AP Chest X-ray following UVC line insertion on day 1
of life showing no consolidation identified within lungs, slightly
hyperinflated right lung. Lung fields show diffuse mild bilateral hazy
opacities suggestive of transient tachypnea of the newborn (TTN) or
respiratory distress syndrome (RDS). The left hemidiaphragm was notably
elevated compared to the right.