Case 1: A Newborn with Acute-Onset Respiratory Distress and Encephalopathy

A term male infant is born to a consanguineous couple by emergency cesarean section for nonprogressive labor. The mother’s antenatal period was uncomplicated. Her first pregnancy resulted in an abortion in the second month of gestation. The newborn’s Apgar scores were 8 and 9 at 1 and 5 minutes, respectively. The infant appears normal soon after birth and formula feeding is started. On the second day, he is noted to have fast breathing for which he is admitted to a local hospital and receives intravenous fluids, antibiotics, and oxygen. However, in view of worsening respiratory distress, the infant is referred to our center on the third day after birth.On admission to our NICU, the infant’s temperature is 97.2oF (36.2oC), he has tachypnea, with a respiratory rate of 90 breaths per minute and minimal intercostal recessions, oxygen saturation is 94% on room air, heart rate is 160 beats per minute, peripheral extremities are warm, capillary refill time is less than 3 seconds, and blood pressure in the right upper limb is 62/29 mm Hg (mean arterial pressure, 40 mm Hg). There is no dysmorphism, weight is 2.7 kg, and head circumference is 36 cm (90th percentile). On systemic examination, the liver edge is felt 3 cm below the right costal margin, and auscultatory …