A premature infant with tachypnea, grunting, retractions, cyanosis, and chest x-ray showing hypoexpansion with air bronchograms most likely has which condition?

• A. Neonatal pneumonia
• B. Congenital heart disease
• C. Hyaline membrane disease
• D. Chronic lung disease of prematurity

Answer: (C)

This question tests recognition of respiratory distress syndrome due to surfactant deficiency in a premature newborn. In prematurity the lungs lack enough surfactant, which normally reduces surface tension and keeps alveoli open. Without it, the alveoli collapse (atelectasis), lung compliance drops, and the infant shows rapid breathing, grunting, retractions, and cyanosis early after birth. The chest X-ray appearance—hypoexpansion with air bronchograms—reflects widespread small-airway and alveolar collapse with air remaining in the bronchi, creating visible air-filled tubes against consolidated/under-aerated lung tissue. This classic combination is most consistent with hyaline membrane disease rather than congenital heart disease or chronic lung disease of prematurity, which typically presents differently (heart disease with cardiomegaly or failure signs, and chronic lung disease of prematurity developing after prolonged oxygen therapy and ventilation). Neonatal pneumonia can mimic distress but the radiographic pattern and timing in a premature infant strongly point to surfactant-deficient hyaline membrane disease.