A newborn male baby, preterm 36 weeks, born via LSCS with APGARs of 4/10 and 5/10 was referred from a private
clinic and admitted to NICU at 3 hours of life with birth asphyxia and antenatal history of oligohydramnios. On
examination weight is 1.1 kg, OFC 27 cms, red reflex is absent bilaterally along with hepatosplenomegaly…..
What is the most likely diagnosis?
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Yes, since crackles (and rhonchi) of airflow obstruction clear with coughing. This is because they originate from air-fluid interfaces of large to medium airways. Conversely, there are some crackles that may appear after coughing (posttussive crackles), especially over the apical lesions of tuberculosis. Hence, the relationship with cough is a good clue to the sound's origin and should be routinely elicited. According to an old saying, you can tell a chest specialist from a generalist because the generalist never asks the patient to cough during auscultation, whereas the specialist always does.
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