Index of suspicion in the nursery (original) (raw)

Neoreviews, 2005

Abstract

A 2,216-g baby boy is born at 37 weeks’ gestation to a 34-year-old gravida 2, para 1 female. The pregnancy was uncomplicated until the day prior to delivery, when a biophysical profile score of 4/8 was obtained on assessment. Fetal heart rate decelerations to 80 beats/min and multiple late decelerations were noted the evening of delivery, and an emergent cesarean section is planned. The male infant is delivered precipitously prior to entering the operating room. Placental abruption is evident after delivery. At birth, the baby is limp but has spontaneous respirations, with a respiratory rate of 60 breaths/min. Mild intercostal retractions are evident. Femoral pulses are weak, but the heart rate is detected at 130 beats/min. On auscultation, heart sounds are not audible. Apgar scores are 7, 7, and 8 at 1, 5, and 10 minutes, respectively. Shortly after initial assessment, continuous positive airway pressure (CPAP) is applied at 4 to 5 cm H2O, and the baby is transported to the neonatal intensive care unit where the blood pressure is 44/16 mm Hg (mean, 27 mm Hg) and the oxygen saturation is 98% (with CPAP). Color and tone are poor, and the baby subsequently receives bag-and-mask ventilation and a bolus of 10 mL/kg normal saline via a peripheral intravenous …

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