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Differential Diagnoses

Differential Diagnoses. Hyaline Membrane Disease.

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Differential Diagnoses

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  1. Differential Diagnoses

  2. Hyaline Membrane Disease • Rule In: Patient was born preterm (34 weeks) with persistent cyanosis of extremities, presented with occasional grunting, subcostal retractions, crackles, and tachypnea of 88 breaths per minute on the first hours of life. The patient might also had perinatal asphyxia due to difficult delivery secondary to breech presentation. • Rule Out: The incidence of HMD decreases significantly after 30-32 weeks of gestation. The patient improved with administration of antibiotics and oxygen.

  3. Hyaline Membrane Disease • Evaluation: CXR is diagnostic and shows diffuse atelectasis with an increased density in both lungs and a fine, granular, ground-glass appearance of the lungs. The small airways are filled with air and are clearly surrounded by the increased density of the pulmonary field, creating air bronchograms.

  4. Transient Tachypnea of the Newborn • Rule In: Patient presented with tachypnea of 88 breaths per minute during the first 24 hours of life, associated with grunting, subcostal retractions, and persistent cyanosis of extremities. Note of minimal improvement with administration of oxygen support. • Rule Out: Physical examination revealed the presence of crackles. Tachypnea did not resolve within 24-48 hours of life. • Evaluation: CXR reveals prominent pulmonary vascular markings, fluid in the intralobar fissures, overaeration, and flat diaphragms.

  5. Persistent Pulmonary Hypertension of the Newborn • Rule In: Patient presented with persistent cyanosis of extremities, associated with occasional grunting, subcostal retractions, and tachypnea of 88 breaths per minute. The patient might also had perinatal asphyxia due to difficult delivery secondary to breech presentation. • Rule Out: The presence of crackles does not support the diagnosis of PPHN. • Evaluation: CXR reveals decreased pulmonary vascular markings.

  6. Neonatal Pneumonia • Rule In: Patient presented with signs of respiratory distress such as tachypnea, subcostal retractions, crackles, and cyanosis of extremities. • Rule Out: Cannot be ruled out.

  7. Diagnostics • Chest X-ray to evaluate the condition of the lungs. Pulmonary infiltrates suggests pneumonia, diffuse atelectasis supports HMD, fluids in intralobar fissures points out to a probable TTN, and decreased lung markings suggests PPHN. • CBC to evaluate if there is an increase in WBC count that supports the presence of probable infection. It would also show probable derangement in RBC and hemoglobin that decrease the oxygen-carrying capacity. • ABG to assess the peripheral oxygen saturation of arterial blood and probable acidosis/alkalosis of the patient. • Bloo CS to document the presence of infection, know the culprit organism and test its sensitivity t particular antibiotics. • Hyperoxia test to differentiate if the disease is secondary to a pulmonary condition or due to a presence of AV shunt. • Serum electrolytes

  8. Laboratory Results

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