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The Case
A newborn term female presents with jittery movements soon after delivery.
Prenatal History
33-year-old primigravida Caucasian mother
Estimated gestational age of 41 weeks
Pregnancy was the product of in vitro fertilization
Maternal blood type, rapid plasma reagin nonreactive, hepatitis B surface antigen negative, rubella immune, group B Streptococcus (GBS) screen negative
Spontaneous rupture of membranes occurred more than 18 hours prior to delivery, and amniotic fluid tinged with light meconium
Mother received five doses of ampicillin for prolonged rupture of membranes
Birth History and Presentation
The delivery occurred at a birthing center. The infant was delivered from vertex presentation by spontaneous vaginal delivery. A pediatric team was present at the delivery. The infant was intubated, and a small amount of meconium was suctioned from the airway. She was depressed, with no respiratory effort, and required resuscitation with bag-mask ventilation. Apgar scores were 2 at 1 minute, 3 at 5 minutes, and 4 at 20 minutes. She received one dose of naloxone without appreciable improvement. At 30 minutes after delivery, the infant had spontaneous respirations, and oxygen saturation was 100% with blow-by oxygen. Birth weight was 4,050 g.
A blood gas drawn from an umbilical venous line revealed:
pH of 7.12
PCO2 of 40.4 mm Hg
PO2 of 112 mm Hg
HCO3 of 13.6 mEq/L (13.6 mmol/L)
Base deficit of 16 mEq/L
A neonatologist was consulted, and the patient was transported to a neonatal intensive care unit. …
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