A preterm neonate at 32 weeks gestation develops respiratory distress within 2 hours of birth with grunting, subcostal retractions, and central cyanosis. Chest X-ray shows a ground-glass appearance with air bronchograms. What is the MOST appropriate initial management?

• A Intravenous antibiotics and blood culture
• B Oxygen supplementation alone via head box
• C Surfactant replacement therapy via endotracheal tube ✓
• D High-frequency oscillatory ventilation

Explanation

The clinical and radiological picture is classic for Respiratory Distress Syndrome (RDS) due to surfactant deficiency, the most common cause of respiratory distress in preterm neonates. Exogenous surfactant instilled via endotracheal tube is the cornerstone of treatment and significantly reduces mortality and air-leak complications. Antenatal corticosteroids accelerate surfactant production when given before delivery.

Reference: Ghai Essential Pediatrics, 10th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.