A 35-week-old neonate with a birthweight of 3,860 g is born via cesarean section secondary to fetal distress. The pregnancy was complicated by maternal pre-eclampsia and insulin-dependent gestational diabetes mellitus. The infant cries immediately after delivery, but then becomes limp and cyanotic. She requires resuscitation with positive pressure ventilation and ultimately undergoes intubation due to hypercarbia. The infant’s Apgar scores are 6, 6, and 7 at 1, 5, and 10 minutes, respectively. Initial arterial umbilical cord gas reveals a pH of 6.9 and Pco2 of 105 mm Hg (14 kPa) with an incalculable base deficit. The infant requires fluid resuscitation with normal saline to correct for metabolic acidosis and multiple dextrose boluses as well as 15% intravenous dextrose as maintenance for persistent hypoglycemia. A blood culture is performed and she is started on empiric ampicillin and gentamicin.

Her initial neurologic examination performed within the first hour after birth...

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