**Core Concept:**
The clinical scenario describes a premature neonate presenting with respiratory distress syndrome (RDS), a condition commonly seen in very low birth weight infants. RDS is caused by immaturity of lung surfactant production, leading to alveolar collapse and subsequent hypoxia, hypercapnia, and tachypnea. This case presents with clinical signs of respiratory distress, including tachypnea, flaring, subcostal and intercostal retractions, and radiological findings of bilateral, diffuse, ground-glass appearance, air bronchograms, and poor lung expansion. These signs and symptoms are indicative of RDS.

**Why the Correct Answer is Right:**
The correct treatment plan for a neonate presenting with respiratory distress due to RDS is supportive care, including:

1. **Positive pressure ventilation (PPV) via a bag-valve-mask (BVM) device or an advanced ventilator.** PPV helps to maintain adequate oxygenation and ventilation, preventing hypoxia and hypercapnia.
2. **Inhalation of surfactant therapy.** Surfactant, a substance that reduces surface tension in the alveoli, helps to stabilize the alveoli and prevent collapse. Intratracheal surfactant administration can significantly improve lung function in infants with RDS.

**Why Each Wrong Option is Incorrect:**
A) **Intermittent positive pressure ventilation (IPPV) is not recommended.** IPPV can cause barotrauma and volutrauma, further damaging the already immature lungs and worsening the condition.

B) **Inhalation of oxygen alone.** Inhaling pure oxygen can lead to oxygen toxicity, causing further lung injury and worsening the condition.

C) **Use of corticosteroids.** Corticosteroids are used to accelerate the maturation of the lungs and reduce the risk of RDS in premature infants, but in this case, the baby has already developed the condition, and corticosteroids would not reverse RDS.

D) **Passive ventilation.** Passive ventilation does not provide adequate oxygenation and ventilation, leading to respiratory distress and worsening the condition.

**Clinical Pearl:**
Infants with respiratory distress should be managed with supportive care, including PPV, surfactant therapy, and avoidance of oxygen toxicity. Oxygen therapy should be titrated to maintain SpO2 between 88-92% to prevent oxygen toxicity. Aggressive ventilation and surfactant therapy can significantly improve the prognosis of RDS in premature infants.