A 28-week preterm neonate on mechanical ventilation develops sudden deterioration with decreased breath sounds on the left, shifted cardiac impulse to the right, and desaturation. Chest X-ray shows hyperlucency on the left with mediastinal shift. The MOST appropriate immediate intervention is:
- A Increase PEEP on ventilator
- B Needle decompression at left second intercostal space, midclavicular line ✓
- C Surfactant administration intratracheally
- D Emergency thoracotomy
Correct answer: B. Needle decompression at left second intercostal space, midclavicular line
Explanation
This presentation describes a tension pneumothorax complicating mechanical ventilation in a preterm neonate — a recognized hazard of positive-pressure ventilation. The mediastinal shift away from the affected side, decreased breath sounds, and hemodynamic compromise mandate immediate needle decompression before formal chest drain insertion. Increasing PEEP would worsen the pneumothorax, and surfactant is not indicated here.
Reference: Ghai Essential Pediatrics, 10th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.