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NeoReviews Vol.10 No.8 2009 e412
© 2009 American Academy of Pediatrics

Index of Suspicion in the Nursery

The first 300 words of the full text of this article appear below.

	Case Presentation

 
A female infant presents with extreme tachycardia and tachypnea on the sixth day after birth. She was born at 35–1/7 weeks’ gestation dated by the mother's last menstrual period and first trimester ultrasonography. The 26-year-old G1P0 mother has a history of anemia and fibroids. Prenatal laboratory results were: AB+ blood type, syphilis screen-nonreactive, hepatitis B surface antigen-negative, human immunodeficiency virus-negative, rubella-immune, and gonorrhea- and chlamydia-negative. Group B streptococcal culture was pending at delivery.

The mother presented in preterm labor several hours after rupture of membranes at home with clear amniotic fluid. The infant was delivered by cesarean section due to progressing preterm labor and a frank breech presentation. The infant initially had poor color, tone, heart rate, and respiratory effort, necessitating neonatal resuscitation. After 2 minutes of positive pressure ventilation, the infant stabilized. Apgar scores were 5 at 1 minute and 8 at 5 minutes after delivery. After resuscitation, the infant continued to have nasal flaring and increased work of breathing and was transferred to the neonatal intensive care unit (NICU) for further management.

Initial vital signs were:

• Weight, 2,185 g (7th percentile)
  
• Length, 46 cm (30th percentile)
  
• Head circumference, 32 cm (30th percentile)
  
• Temperature, 36.6°C
  
• Heart rate, 152 beats/min
  
• Respiratory rate, 58 breaths/min
  
• Blood pressure, 76/46 mm Hg
  
• Oxygen saturation, 92% on room air
  

On physical examination, the infant had mild respiratory distress and a soft 2/6 systolic murmur over the apex, but other findings were normal. She was placed on oxygen via nasal cannula while an initial chest radiograph and blood gas were obtained. An intravenous catheter was placed and infusion of a 10% dextrose solution at 60 mL/kg per day was started. A complete blood count and blood culture were obtained and empiric antibiotic therapy with ampicillin and gentamicin for possible sepsis was initiated.

The infant's respiratory . . . [Full Text of this Article]

John Podraza, MD

Department of Neonatology, National Naval Medical Center, Assistant Professor of Pediatrics, Uniformed Services University, Bethesda, Md

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