A Newborn Infant with Hand Nodule Following Intravenous Extravasation

A male infant is born at 39 weeks and 5 days of gestation to a 22-year-old primigravida via spontaneous vaginal delivery. The labor course is complicated by premature rupture of membranes (ROM) for 22 hours, preeclampsia, and non-reassuring fetal heart rate. The mother receives azithromycin, cefazolin, and penicillin G for prolonged ROM. The infant’s birthweight is 3,240 g (41st percentile), length 48.3 cm (20th percentile), and head circumference 34 cm (36th percentile). His Apgar scores are 9 and 9 at 1 and 5 minutes, respectively. The infant is initially admitted to the well newborn nursery. Within the first hour after birth, he begins to show signs of respiratory distress with grunting, nasal flaring, and retractions. He is transferred to the NICU for further management. NICU and admission vital signs are as follows: temperature 99.1°F (37.2°C), heart rate 178 beats/min, respiratory rate 48 breaths/min, and oxygen saturation 89% in room air....