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Background
Neonatal respiratory distress (NRD) is defined as respiratory dysfunction in the immediate postnatal period secondary to a congenital or acquired insult, primarily affecting premature neonates. Chest radiography is the primary imaging modality for differentiating between the numerous etiologies of NRD. The purpose of this exhibit is to aid in the early recognition and prompt diagnosis of NRD, which is imperative for decreasing the morbidity and mortality of at-risk neonates.

Educational Goals / Teaching Points
The primary goal of this educational exhibit is to provide an abridged radiographic review of the common medical and surgical causes of NRD as well as the impact of prompt diagnosis on neonatal morbidity and mortality.

Key Anatomic/Physiologic Issues and Imaging Findings/Techniques
Medical NRD and their Imaging Findings. Transient tachypnea of the newborn results from an impairment in lung fluid clearance. Chest x-ray (CXR) demonstrates evidence of fluid overload in the bilateral lungs with or without hyperinflation. Persistent pulmonary hypertension of the newborn can lead to congestion and an enlarged cardiac silhouette as evidenced on CXR. Respiratory distress syndrome is a severe cause of NRD. CXR findings demonstrate diffuse bilateral reticulogranular densities, air bronchograms and lung hypoinflation. Meconium aspiration syndrome results in bronchial obstruction and CXR demonstrates lung hyperinflation, atelectasis and coarse interstitial opacities. Neonatal pneumonia is a combination of a clinical and radiographic diagnosis with CXR findings that can resemble RDS or meconium aspiration. Surgical NRD and their imaging findings. Pulmonary sequestration can present as a mass or consolidation most commonly in the medial left lower lobe. Congenital lobar hyperinflation presents on CXR as a solid-appearing mass early, and later with hyperinflation and oligemia. Congenital pulmonary airway malformations present as small to large cysts on CXR depending on the subtype. Congenital diaphragmatic hernia appears as a mass in the lower chest that contains bowel gas. Complications of NRD and their Imaging Findings. Air leaks are a common short-term complication of NRD and include pneumomediastinum, pneumothorax, pneumopericardium, and pulmonary interstitial emphysema. Bronchopulmonary dysplasia is a long-term complication of ventilation that leads to chronic inflammation and fibrosis visible on CXR.

Conclusion
Prompt diagnosis of NRD is of utmost importance, especially in premature neonates. Respiratory distress syndrome is the leading cause of morbidity and mortality among preterm infants. While chest radiography provides diagnostic accuracy, it comes with the risks of radiation exposure. To reduce this burden, lung ultrasounds have been utilized for certain etiologies of NRD. However, its diagnostic value is to be further studied.