Index of Suspicion in the Nursery

Presentation

A 34-week preterm baby (triplet C) is born of a triplet gestation to a 29-year-old gravida 2 para 3 mother after conception by in vitro fertilization. The mother is on thyroxine hormone for hypothyroidism and glyburide for diabetes mellitus. Delivery is by cesarean delivery at 34 weeks’ gestation due to progressively worsening maternal hypertension and a low biophysical profile of triplet B. Delivery room stabilization includes positive pressure ventilation, intubation, and surfactant administration. Apgar scores are 6 at 1 minute and 8 at 5 minutes. Birthweight is 2,380 g (50th–75th percentile), length is 46 cm (50th–75th percentile), and head circumference is 33.4 cm (75th–90th percentile). He is extubated to continuous positive airway pressure in a few hours, and respiratory support is weaned to humidified high flow through nasal canula. Feedings are commenced when he is 4 days old and gradually advanced. He vomits and has desaturation with worsening respiratory distress and requires increased respiratory support with each attempt to increase feeds. Radiologic evaluation reveals progressively worsening parenchymal haziness (Figs …