Question

a full term neonate who is apparently normal at birth is found to develop neonatal respiratory distress syndrome a few hours after birth. on questioning it was discovered that this occurred soon after the baby had ingested milk for the first time. based on this information, what is the probable diagnosis in this infant?
surfactant deficiency
tracheoesophageal fistula
congenital pyloric stenosis
lactose intolerance

Explanation:

1. Surfactant deficiency: Usually presents at birth or shortly after, related to lung maturation, not triggered by milk ingestion.
2. Tracheoesophageal fistula (TEF): When a baby with TEF ingests milk, it can enter the trachea, causing respiratory distress (like neonatal respiratory distress syndrome - like symptoms) shortly after feeding. This matches the scenario of distress after first milk ingestion.
3. Congenital Pyloric stenosis: Causes vomiting (not respiratory distress) due to obstruction at the pylorus, onset is later (usually 2 - 8 weeks), and not related to milk - induced respiratory issues.
4. Lactose intolerance: Presents with gastrointestinal symptoms (diarrhea, bloating) after lactose intake, not respiratory distress.

Answer:

B. Tracheoesophageal fistula