A male infant is born via vaginal delivery at 29 weeks’ estimated gestation with a birthweight of 1,490 g to a 22-year-old gravida 1, para 1 woman who presented with preterm labor. No maternal risk factors are identified; all maternal prenatal laboratory findings are negative. Group B Streptococcus carrier status is unknown and no intrapartum antibiotic prophylaxis or betamethasone had been administered because it was a precipitous delivery. The infant’s Apgar scores are 8 and 9 at 1 and 5 minutes, respectively. Physical examination findings are normal, with mild retractions. The infant initially undergoes intubation for surfactant therapy and is started on broad-spectrum antibiotics to rule out sepsis and total parental nutrition (TPN). One day after birth, he is weaned to continuous positive airway pressure and gradually to room air.

Routine echocardiography shows a large patent ductus arteriosus which is treated with acetaminophen with subsequent closure and trivial aortic insufficiency...

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