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NeoReviews Vol.8 No.4 2007 e173
© 2007 American Academy of Pediatrics

Index of Suspicion in the Nursery

The first 20% of the full text of this article appears below.


   Case Presentation
 
A preterm male infant, delivered by cesarean section at 30 weeks of gestation, develops severe respiratory distress (RDS) at birth. His 19-year-old primiparous Hispanic mother has no significant previous medical or social history. She had three prenatal visits, and her serology for hepatitis B virus, syphilis, and human immunodeficiency virus were negative. Rubella immunity was documented, and chlamydia and gonococcal cultures were negative. She had come to the hospital 24 hours after rupture of membranes, and late fetal decelerations as well as a nonreassuring fetal heart rate prompted cesarean section. At the time of delivery, the mother had no fever, although leukocytosis was present, with a white blood cell count of 22x103/mcL (22x109/L) with 64% neutrophils, 21% bands, 11% lymphocytes, 1% basophils, and 3% monocytes by manual differential count. Maternal group B Streptococcus status was unknown at the time of delivery. The mother received no intrapartum antibiotics.

The baby's Apgar scores are 3 at 1 minute, 7 at 5 minutes, and 7 at 10 minutes. He requires stimulation and bag-valve-mask ventilation after delivery and is given positive pressure ventilation during transport to the neonatal intensive care unit (NICU). Initial vital signs in the NICU are:

Due to the development of marked respiratory distress, deep retractions, and poor . . . [Full Text of this Article]

Deepthi Alapati, MD
Paola Pablo-Prino, MD
Robert J. Leggiadro, MD

Lincoln Medical and Mental Health Center, Bronx, NY, and Weill Medical College of Cornell University, New York, NY


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Copyright © 2007 by the American Academy of Pediatrics.