A term female infant is born to a 30-year-old gravida 3, para 3-0-1-3 woman in an emergency cesarean delivery for fetal bradycardia. The pregnancy had been complicated by a ventricular septal defect (VSD) with small ascending aorta as noted on fetal echocardiography. The infant is noted to be depressed at birth with poor respiratory effort and bradycardia. Her Apgar scores are 1 and 7 at 1 and 5 minutes, respectively, and her initial cord blood gas values are as follows: Po2 6.99 mm Hg (0.93 kPa), Pco2 83 mm Hg (11.04 kPa), bicarbonate 17 mg/dL (17 mmol/L), base deficit −19.9 mEq/L (−19.9 mmol/L). She is admitted to the NICU on continuous positive airway pressure. A comprehensive physical examination is remarkable for lethargy, hypotonia, nuchal skin redundancy, low-set ears, wide-spaced nipples, and marked splenomegaly.

She meets the criteria for therapeutic hypothermia and full body cooling is initiated....

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