Case 3: Term Infant With Severe Respiratory Failure.

A female neonate born at 39 weeks of gestation is transferred from the well newborn nursery 7 hours after birth because of apnea and cyanosis. The infant is born via elective repeat cesarean section. The pregnancy had been complicated by chronic hypertension and gestational diabetes mellitus. Maternal medications during pregnancy were labetalol and metformin. The maternal perinatal screening results were unremarkable. Membranes ruptured at the time of delivery. Apgar scores are 9 and 9 at 1 and 5 minutes, respectively. Arterial cord pH is 7.29, with a base deficit of −4.3. The infant appears well after delivery, and hence is transferred to the newborn nursery to remain with the mother. Around 7 hours after birth, the infant is cold, and her temperature is \u003c34°C. At the same time, she has apnea and severe cyanosis. She is not improving with positive pressure ventilation. She subsequently undergoes intubation and is admitted to the NICU for further evaluation and management.\n\nOn admission, the infant’s physical examination shows her weight to be 2,690 g (11th percentile), temperature 96.8°F (36°C), and heart rate 147 beats/min. She is noted to have tachypnea, with a respiratory rate of 68 breaths/min, and oxygen saturation of 85% on 50% fraction of inspired oxygen. The rest of the physical examination shows normocephalic head with no signs of trauma. The …