Answer

Respiratory distress syndrome

This is the most common, serious respiratory disorder in neonates (Table 1.16). It is caused by lack of surfactant (normally produced by type II pneumocytes). It is a condition usually associated with prematurity but may also occur in term neonates of diabetic mothers or following birth asphyxia. The normal time of onset is at 18-24 hours of life. The radiological signs are initially of under-inflated lungs which have a granular appearance. With worsening disease air bronchograms become more prominent and this can partially obscure the mediastinal contours. Very premature babies and those with bad respiratory distress syndrome (RDS) are treated with surfactant (administered via an endotracheal tube) which usually produces a marked improvement in their condition.

Table 1.16 Possible causes of respiratory distress in a neonate

■ Respiratory distress syndrome

■ Transient tachypnoea of the newborn

■ Aspiration

■ Pneumothorax

■ Diaphragmatic hernia

■ Congenital heart disease

Complications of respiratory distress

Most of the complications are secondary to mechanical ventilation. Small airway rupture can lead to air tracking into the pleural space -pneumothorax or the mediastinum - pneumomediastinum.

Pneumomediastinum usually produces a sharp clearly defined lucency adjacent to each side of the mediastinum. The mediastinal borders are usually of increased sharpness as they become outlined by air rather than lung parenchyma (see Fig. 1.83). A horizontal beam lateral radiograph will confirm the location of the air. The lungs are poorly compliant in RDS, so do not collapse. The air can often be seen outlining the thymus as well as the other mediastinal structures (see Fig. 1.84).

Fig. 1.84 Neonatal pneumomediastinum lateral projection. The patient is positioned supine and a shoot through lateral projection has been performed. This is outlining the thymus and other mediastinal structures.

1-day-old infant with respiratory difficulties.

Fig. 1.85 Quiz case.

1-day-old infant with respiratory difficulties.

Fig. 1.85 Quiz case.

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