A 30-week neonate on mechanical ventilation develops sudden respiratory deterioration with hypotension and distended abdomen. Transillumination of the chest is positive on the right side. The MOST immediate intervention is:
- A Immediate chest X-ray before any intervention
- B Increase PEEP to recruit the collapsed right lung
- C Needle decompression at right 2nd intercostal space, midclavicular line ✓
- D Emergency bronchoscopy to remove mucous plug
Correct answer: C. Needle decompression at right 2nd intercostal space, midclavicular line
Explanation
Sudden deterioration with positive transillumination in a ventilated preterm strongly indicates tension pneumothorax. Positive transillumination (light transmitted through the hemithorax) is highly specific for pneumothorax in neonates. This is a life-threatening emergency requiring immediate needle decompression before any imaging. Increasing PEEP in a tension pneumothorax would be catastrophically harmful. Chest X-ray should not delay treatment when clinical diagnosis is clear.
Reference: Ghai Essential Pediatrics, 10th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.