A female infant is born precipitously via vaginal delivery after spontaneous rupture of membranes. The mother is a 24-year-old African American woman whose history includes 2 cesearean deliveries with no other medical concerns. The current pregnancy is complicated by limited prenatal care. The gestational age is unknown. The infant’s birthweight is 1,870 g, and her Ballard score is consistent with an estimated 32 weeks of gestation.

In the delivery room, the neonate has a spontaneous cry but with frothy oral secretions and a low heart rate requiring positive pressure ventilation, intubation, and brief cardiopulmonary resuscitation. Apgar scores are 5 and 7 at 1 and 5 minutes, respectively. Physical examination is significant for extensive blistering of her face, neck, chest, and extremities. She is placed in a plastic bag for skin protection, thermoregulation, and reduction of insensible water losses. The patient is then transferred to the NICU, where mechanical ventilation is...

You do not currently have access to this content.