A term neonate at 6 hours of life develops respiratory distress, tachypnea, and grunting. Chest X-ray shows a 'ground glass' appearance with air bronchograms bilaterally. The mother had an elective cesarean section at 38 weeks. What is the MOST likely diagnosis?

• A Transient tachypnea of newborn (TTN)
• B Congenital pneumonia
• C Meconium aspiration syndrome
• D Hyaline membrane disease (Respiratory distress syndrome) ✓

Explanation

Although RDS is classically a disease of prematurity, late-preterm (34–36 weeks) and early-term (37–38 weeks) neonates delivered by elective cesarean section are at elevated risk due to relative surfactant deficiency and absence of labor-induced catecholamine surge that normally clears lung fluid. The bilateral ground-glass appearance with air bronchograms is the classic X-ray finding of RDS, not TTN (which shows streaky perihilar vascular markings and fluid in fissures). TTN typically resolves within 24–72 hours and has a distinct radiologic appearance.

Reference: Ghai Essential Pediatrics, 10th ed.

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Written and medically reviewed by the StethoPrep medical team.