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Findings Bank
A Tension Pneumothorax
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B Surfactant Deficiency
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C Pulmonary Hemorrhage
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D Duct-Dependent Lesion
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Neonatal Decompensation Cheatsheet
Key Concept: Sudden acute decompensation in premature neonate on CPAP: asymmetric breath sounds + transillumination brightness + contralateral heart shift = tension pneumothorax. Emergent needle decompression (2nd ICS, MCL on affected side) is the immediate next step — do not wait for CXR.
Diagnosis
Key Features
Tension Pneumothorax
Sudden onset respiratory + hemodynamic collapse
Decreased breath sounds on affected side
Tracheal/mediastinal shift AWAY from affected side
Positive transillumination on affected side
Immediate needle decompression (2nd ICS, MCL)
Follow with chest tube after needle decompression
Risk increased with CPAP/PPV
CXR: hyperlucency + collapsed lung (confirm after stabilization)
Surfactant Deficiency
Gradual onset from birth (not sudden decompensation)
Bilateral decreased breath sounds
Bilateral ground-glass opacity on CXR
Worsens progressively over 4-6 hours
Treated with exogenous surfactant + CPAP
No asymmetry; no transillumination difference
Does NOT cause sudden acute decompensation after initial stabilization