A male newborn is delivered at 35 -6/7 weeks’ gestational age with a birthweight of 2,700 g (50th percentile) to a gravida 3, para 2, 33-year old mother by elective lower segment cesarean section for prolonged rupture of membranes. Fetal ultrasound is unremarkable; a complete course of antenatal steroids and 2 doses of benzylpenicillin are administered. Apgar scores are 7 and 9 at 1 and 5 minutes, respectively. Maternal history is unremarkable except for a treated urinary tract infection at 33 weeks. Group B streptococcal screening is negative. Umbilical arterial blood gas shows a pH of 7.30; base deficit of 1.5 mmol/L; and lactate of 3.6 mmol/L.

At 1 hour of age, the infant is noted to have cyanosis and tachypnea, with respiratory rates of 80 to 90 breaths per minute, requiring 50% of incubator oxygen and subsequently nasal continuous positive airway pressure to maintain oxygen saturation of 91% to...

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