DDX of respiratory distress in neonate (pre-term or term) – surgical causes

Approach to DDX of surgical causes of respiratory distress in the neonate (pre-term or term):

  • Congenital diaphagmatic hernia fills an entire hemithorax with solid organs and or air filled loops of bowel
  • Congenital lobar emphysema usually is in an upper lobe and may initially be fluid filled, when it aerates it is a large single cyst
  • Congenital pulmonary airway malformation can be in any lobe and may initially be fluid filled, when it aerates it is composed of multiple cysts
  • Hydrothorax – causes of large pleural effusions in newborns are chylothorax (most common), congestive heart failure, erythroblastosis fetalis, urine ascites. Neonatal pneumonia causes a small pleural effusion
  • Pneumothorax as an isolated finding on an initial CXR may be associated with underlying renal disease