Examination of a 6-hour-old infant delivered with difficulty by low forceps reveals an asymmetric Moro reflex involving the right arm. Infant is cyanotic and has labored respiration. Abdomen does not bulge with inspiration, and there are decreased breath sounds in the right chest. Most likely diagnosis is?

Ans:C.)Ipsilateral paralysis of the diaphragm . Phrenic nerve injury with ipsilateral diaphragmatic paralysis must be suspected in this infant. The abdomen does not bulge with the breathing is mostly thoracic. Diagnosis is made during fluoroscopy, Respiratory distress syndrome is more seen in preterm infants and presents with cyanosis, tachypnea and grunting respirations. The mother usually has a history of difficult delivery. Chest x-ray reveals a ground-glass appearance. Meconium aspiration syndrome appears at bih, usually in term or post-term infants. There is a history of meconium-stained amniotic fluid. When meconium is aspirated into the lungs, respiratory distress may occur within the first hours of life. Overdistention of the chest may be present. Meconium aspiration syndrome is not associated with an asymmetric Moro reflex. Tracheoesophageal fistula presents as choking and cyanosis with feeding. It should be suspected in cases of maternal polyhydramnios, or excessive oral secretions of the infant. Choanal atresia is suspected in a cyanotic newborn who becomes pink on crying, and the diagnosis is made by failure to pass a catheter through the nasal passages.