TYK388
A 2 month-old infant born at 34 weeks postmenstrual age arrives in the preoperative area with his parents for bilateral inguinal hernia repair. He was in the NICU for three weeks “because his breathing was bad and he needed oxygen,” per the parents. No NICU records are available, but the mother states she developed diabetes during the pregnancy. He is currently on no medications or oxygen support. You suspect a history of RDS, necessitating NICU admission. Of the following, choose the BEST statement:
a) This history is also consistent with TTN, especially given his gestational age
b) The chest x-ray in RDS usually shows hyperinflation and fluid in the minor fissure
c) Mature levels of surfactant are present in fetal lungs by 32 weeks
d) Administration of antenatal betamethasone was indicated in this case, given both the gestational age at birth and the history of maternal diabetes
e) RDS usually presents with cyanosis in the absence of respiratory distress
Answer
Answer d. Antenatal steroids are indicated for both of the reasons outlined in this case. TTN symptoms should resolve well before the infant is 3 weeks old. The CXR described is consistent with TTN, not RDS. At 32 weeks, surfactant levels are usually not yet mature. Respiratory distress is a prominent component of RDS in most cases.
Notes
- This question originally printed in the Pediatric Anesthesiology Review Topics kindle book series, and appears courtesy of Naerthwyn Press, LLC.