A female neonate is born via spontaneous vaginal delivery to a 19-year-old primiparous woman at 35 1/7 weeks of gestation at a rural hospital following an uncomplicated pregnancy. The neonate initially cries at delivery but soon becomes apneic and bradycardic. She is resuscitated with positive pressure ventilation, chest compressions, and a dose of epinephrine via emergent umbilical vein catheter. Her heart rate is subsequently stable in a normal range for age. During the resuscitation, endotracheal intubation is not successful so she receives ventilation via laryngeal mask airway. Her Apgar scores are 1, 1, 4, 5, and 7 at 1, 5, 10, 15, and 20 minutes, respectively. Her physical examination findings immediately after resuscitation are pertinent for diffuse hypotonia and decreased responsiveness. Her blood gas shows a severe mixed acidosis with pH 6.7, partial pressure of carbon dioxide 68 mm Hg (9 kPa), and base deficit 27.

She undergoes intubation and...

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