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The Case:
Upper gastrointestinal tract mass and respiratory failure in a newborn
Prenatal History:
A 20-year-old primigravida female who has chronic hypertension, oligohydramnios, and maternal class B diabetes
Nonreactive rapid plasma reagin, negative hepatitis B surface antigen, and presence of rubella antibodies; culture for group B Streptococcus (GBS) not performed
Birth History and Presentation:
Infant delivered via cesarean section at 29 weeks’ gestation, weighing 1,030 g
Apgar scores of 6 and 8 at 1 and 5 minutes, respectively; infant required oxygen and positive pressure ventilation in the delivery room and oral suction
The patient was started on nasal continuous positive airway pressure in the neonatal intensive care unit at 7 cm H2O and 27% Fio2, with placement of a nasogastric tube and received antibiotics because of prematurity, respiratory distress, and unknown maternal GBS status
Three hours after birth, the baby’s respiratory condition deteriorated, necessitating intubation and placement on a conventional ventilator
The baby’s respiratory condition worsened on the second postnatal day, and chest radiography revealed an abnormal air-filled structure in the superior mediastinum (see Fig. 1)
Case Progression:
The infant was switched to high-frequency jet ventilation on postnatal day three. Her respiratory condition improved, …
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