A late preterm neonate is born with an occipital encephalocele and other anomalies.

The neurosurgery, otolaryngology, and neonatology departments were present at delivery. The encephalocele was large (Fig 1) and was initially placed in a sterile bag. Some spontaneous breaths were noted. Given the infant’s micrognathia, the otolaryngology team provided nasal intubation and placed the infant on positive pressure ventilation (Fig 2). The encephalocele was cleaned, wrapped in wet gauze, and placed in a polyethylene skin wrap by the neurosurgery team. The infant’s Apgar scores were 2, 6, and 8 at 1, 5, and 10 minutes, respectively. Before arrival at the NICU, a peripheral intravenous line was placed. The infant required 2 dextrose boluses to obtain a normal serum glucose value, and 1 normal saline fluid bolus to maintain appropriate blood pressure. She was then brought to the NICU and placed on assisted ventilation.

The neonatal...

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