What is an appropriate initial management step for suspected infant respiratory distress syndrome in a preterm newborn?

• A. Nasal continuous positive airway pressure
• B. Immediate intubation with ventilation for all cases
• C. Immediate chest tube placement
• D. Exogenous surfactant without assessment

Answer: (A)

Early noninvasive respiratory support with nasal CPAP is the appropriate initial step because surfactant deficiency in preterm infants leads to widespread alveolar collapse and low lung compliance. CPAP provides a continuous positive pressure that keeps alveoli open at the end of expiration, improves functional residual capacity, enhances oxygenation, and reduces the work of breathing. It also lowers the risk of ventilator-associated injury compared with immediate intubation. Surfactant replacement remains essential when CPAP isn’t enough to maintain adequate gas exchange or if distress worsens, but it should follow assessment of the infant’s response to noninvasive support. Immediate chest tube placement isn’t indicated, and surfactant should not be given without clinical need.