A 2,450-g male newborn is delivered after a full-term gestation by a 35-year-old gravida 2, para 0, aborta 1 woman. The pregnancy was complicated by maternal substance abuse (alcohol, tobacco, and cannabis) as well as intrauterine growth restriction. At delivery, the infant is noted to be dusky, in moderate respiratory distress, and requiring respiratory assistance with continuous positive airway pressure (CPAP). Capillary blood gas is measured on arrival to the NICU, which reveals a pH of 7.22, partial pressure of carbon dioxide (Pco2) of 59 mm Hg (7.9 kPa), partial pressure of oxygen (Po2) of 37 mm Hg (4.9 kPa), and base deficit of –4. On physical examination, his weight is 2.45 kg (less than the 3rd percentile), length is 46.5 cm (10th percentile), and head circumference is 32 cm (3rd percentile.) Vital signs reveal a temperature of 97.7°F (36.5°C); heart rate of 176...

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