Paeds Cases · fetal-neonatal-and-perinatal
Neonatal respiratory distress — diagnostic approach — structured clinical encounter
Structured encounter testing the diagnostic approach to a preterm infant with respiratory distress: recognition, CXR interpretation, the CPAP-first and surfactant decision, and exclusion of a complicating pneumothorax and sepsis.
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RACP General PaediatricsRACP DCEMRCPCH ClinicalRCPSC Pediatrics
Prompt
A 29-week gestation infant born to a mother with preterm labour and incomplete antenatal steroids develops increasing respiratory distress within the first hour. You are the neonatal registrar working through the diagnosis and stepwise management with the team.
Station brief (candidate)
You are the neonatal registrar. A 29-week gestation infant is admitted to the neonatal unit with grunting, subcostal recession and a rising oxygen requirement on CPAP 5 cm within the first hour of life. The mother received one dose of antenatal steroids. The team asks you to establish the diagnosis and the management plan. You have 12 minutes with the team and 5 minutes for examiner discussion. [1]
References6ShowHide
- [1]Sweet DG; Carnielli VP; Discenza M; et al European Consensus Guidelines on the Management of Respiratory Distress Syndrome: 2022 Update. Neonatology, 2023.PMID 36863329
- [2]Polin RA; Carlo WA; Committee on Fetus and Newborn Surfactant replacement therapy for preterm and term neonates with respiratory distress. Pediatrics, 2014.PMID 24379227
- [3]Finer NN; Carlo WA; Walsh MC; et al Early CPAP versus surfactant in extremely preterm infants. N Engl J Med, 2010.PMID 20472939
- [4]Härtel C; Hartz A; Kribs A; et al Association of Administration of Surfactant Using Less Invasive Methods With Outcomes in Extremely Preterm Infants. JAMA Netw Open, 2022.PMID 35943742
- [5]Aziz K; Lee CHC; Escobedo MB; et al Part 5: Neonatal Resuscitation 2020 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Pediatrics, 2021.PMID 33087555
- [6]Madar J; Roehr CC; Ainsworth S; et al European Resuscitation Council Guidelines 2021: Newborn resuscitation and support of transition of infants at birth. Resuscitation, 2021.PMID 33773829