A Term Newborn Who Has Jittery Movements

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. …