A term baby develops respiratory distress with prominent tachypnoea. The mother had ruptured membranes for 24 hours, a fever in labour, and the chest X-ray is difficult to distinguish from RDS. What is the most likely diagnosis and its specific treatment?

Answer: D. Congenital pneumonia (often group B streptococcus); intravenous antibiotics (penicillin and gentamicin)

Congenital pneumonia

Respiratory distress in a term baby with maternal risk factors - prolonged rupture of membranes (>18 hours), maternal pyrexia, chorioamnionitis - suggests congenital pneumonia, most commonly due to group B streptococcus (GBS).

Features

• Tachypnoea is a prominent feature; surfactant is inactivated by exudate/pus, so it can be difficult to differentiate from RDS on X-ray.
• It can present even before 6 hours (consider RDS/TTN/MAS too in that window).

Specific treatment

• Intravenous antibiotics - penicillin and gentamicin - given promptly.
• Investigations: FBC, CRP, blood culture (positive in only ~10%), surface swabs.

Why the others are wrong

TTN needs no antibiotics; MAS needs a meconium context; pneumothorax gives unilateral signs and needle decompression; diaphragmatic hernia has a scaphoid abdomen. The maternal sepsis risk factors point to congenital pneumonia needing antibiotics.