A term male infant born by elective cesarean section at 38 weeks without labor develops tachypnea of 90 breaths per minute at 1 hour of life with mild retractions and occasional grunting. He needs only 25% oxygen. Chest X-ray shows prominent perihilar vascular markings, a small pleural effusion, fluid in the horizontal fissure, and mild hyperinflation. Blood cultures are sent. What is the MOST likely diagnosis?

• A Meconium aspiration syndrome
• B Respiratory distress syndrome
• C Neonatal pneumonia
• D Transient tachypnea of the newborn ✓

Explanation

Transient tachypnea of the newborn follows delayed resorption of fetal lung fluid, classically after cesarean delivery without labor, since the catecholamine surge and thoracic squeeze of labor are bypassed. Radiographs show perihilar streaking, fissure fluid and hyperinflation, and symptoms resolve within 24 to 72 hours. Respiratory distress syndrome is seen in preterm infants with ground glass appearance, while pneumonia and meconium aspiration typically cause progressive rather than spontaneously resolving distress.

Reference: Nelson Textbook of Pediatrics, 21st ed.

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Written and medically reviewed by the StethoPrep medical team.