Case 121

Case 121

Medical History

A male newborn delivered by cesarean section at 33 weeks of gestation (due to insulin-dependent maternal diabetes and abnormalities of fetal vitality) presents with respiratory discomfort at birth (Silverman-Andersen score 4/10). He is treated with early nasal CPAP and transferred to the neonatal intensive care unit. At 3 hours of life, he is intubated and connected to mechanical ventilation due to deterioration of his respiratory status (S-A score 8/10) and a chest radiography is requested (image 1). Clinical improvement is noted after surfactant administration and another chest radiograph is taken (image 2). At 8 hours of life, he presents with central cyanosis, lack of pulses and bradycardia; cardiopulmonary resuscitation is performed, along with thoracocenthesis and chest radiography (image 3).

Image 1: Anteroposterior chest radiography.


Image 2: Anteroposterior chest radiography.


Image 3: Anteroposterior chest radiography.


Based on the clinical history and images presented, the most likely diagnosis and the resulting complication are, respectively: