X-ray of neonate born 34 weeks with premature rupture of membranes. CXR was performed. All are considered in differential diagnosis except?

Ans. (d) Ventricular septal defect.* In the differential diagnosis, early-onset sepsis may be indistinguishable from RDS. In pneumonia manifested at birth, the chest roentgenogram may be identical to that for RDS. Maternal group B streptococcal colonization, organisms on Gram stain of gastric or tracheal aspirates or a buffy coat smear, and/or the presence of marked neutropenia may suggest the diagnosis of early-onset sepsis.* Cyanotic heart disease (total anomalous pulmonary venous return) can also mimic RDS both clinically and radiographically. Echocardiography with color flow imaging should be performed in infants who fail to respond to surfactant replacement to rule out cyanotic congenital heart disease as well as ascertain patency of the ductus arteriosus and assess pulmonary vascular resistance.* Congenital alveolar proteinosis (congenital surfactant protein B deficiency) is a rare familial disease that manifests as severe and lethal RDS in predominantly term and near-term infants.* In atypical cases of RDS, a lung profile (lecithin: sphingomyelin ratio and phosphatidylglycerol level) performed on a tracheal aspirate can be helpful in establishing a diagnosis of surfactant deficiency. Image source. style="font-size: 1.04761904761905em; color: rgba(0, 0, 0, 1); font-family: Times New Roman, Times, serif; margin: 0 0 0 8px; text-indent: 0">