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.