Approach to respiratory distress (newborn) Quiz: Ace Your Exams

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An infant girl is delivered by vaginal delivery at 40 weeks gestational age. She is evaluated in the neonatal intensive care unit for respiratory distress. Prenatal history reveals normal ultrasound, no maternal fevers, and negative GBS. Rupture of membranes was at delivery and the amniotic fluid was stained with thick meconium. She is limp and cyanotic at birth with minimal respiratory effort. Weight is 4400-g (9.7 lbs). Apgar scores are 2 and 7 at 1 and 5 minutes, respectively. Temperature is 37.2°C (99°F), pulse is 177 beats/minute, respiratory rate is 80/minute and SpO2 is 93% on nasal cannula with FiO2 40%. Physical examination reveals meconium-stained skin, nasal flaring, subcostal and suprasternal retractions with a barrel-shaped chest. On auscultation, coarse rhonchi are noted on the chest bilaterally and there is no heart murmur. Abdominal exam is normal. Which of the following tests will confirm the most likely diagnosis?  

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