Neonatal respiratory distress syndrome Quiz: Ace Your Exams

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A 3-hour-old male newborn delivered at 28 weeks gestation is being evaluated for increased work of breathing. The patient was born to a mother with a history of diabetes and inconsistent prenatal care. His temperature is 38 °C (100.4°F), pulse is 219/min, respirations are 81/min, blood pressure is 64/41 mmHg, and oxygen saturation is 87% on room air. Physical exam shows a mildly cyanotic infant with tachypnea, nasal flaring, and subcostal retractions. Auscultation demonstrates diminished breath sounds bilaterally.  A chest x-ray is shown below:  

An X-ray shows an infant's chest and abdomen, with visible ribs, lungs, and diaphragm. Several medical tubes are present across the body.
Reproduced from: Radiopaedia   
Which of the following is the most likely diagnosis?  

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