Acute respiratory distress syndrome or pneumonia? The role of lung ultrasound

Abstract

Background. Neonatal Acute Respiratory Distress Syndrome (ARDS), although recognized for almost 34 years, is still difficult to define. An attempt was made to include this pathology in a set of criteria (The Montreux definition) that allows early diagnosis and appropriate therapeutic measures. Case report. We present one case of neonatal ARDS that was diagnosed using the Montreux definition. Two out of the five criteria were discovered while performing seriated lung ultrasounds. A term newborn (GA=39W6D) developed respiratory failure at 15 minutes after birth: rapid, labored, grunting respirations, suprasternal and substernal retractions. The suspected diagnosis was ARDS because all 5 criteria were met. The infant was transferred to the NICU where CPAP treatment and antibiotic prophylaxis were initiated. Lung ultrasounds were performed, showing congenital pneumonia as the primary acute respiratory condition so the antibiotics were changed. In the second day of life the patient was sedated and received mechanical ventilation support followed by 3 doses of surfactant. The patient’s status slowly improved and he was extubated after 56 hours. The lung ultrasounds began to show a normal pattern; blood cultures were negative, and CRP was decreasing. The patient was discharged at 8 days of life. Conclusions. When faced with a term newborn with respiratory distress it is important to consider ARDS as a possible diagnosis if all the criteria are met.