Ans: A. Neonatal pulmonary alveolar proteinosis(Ref. Nelson 20/e p852, 2119)Suggestive of neonatal pulmonary alveolar proteinosis.Pulmonary alveolar proteinosis:Disorder characterized by intra-alveolar accumulation of pulmonary surfactant.Two clinically distinct forms of pulmonary alveolar proteinosis are seen:Fatal form: Presenting sholy after bih (congenital PAP)Gradually progressive form: Presenting in older infants & children.Clinical manifestation:Immediately apparent in the newborn period & rapidly leads to respiratory failure.Clinically and radiographically indistinguishable from more common disorders of the newborn that lead to respiratory failure including pneumonia, generalized bacterial infection, respiratory distress syndrome and total anomalous pulmonary venous return with obstruction.