A Preterm Infant Who Has Acute Respiratory Decompensation

Abstract

A 4-day-old preterm male infant presents with respiratory failure requiring 100% oxygen on assisted ventilation. ### Prenatal History: ### Birth History and Presentation: The infant was delivered by the vaginal route in vertex presentation. He had initial poor respiratory effort, but responded to warming, stimulation, and blow-by oxygen. Apgar scores were 7 at 1 minute and 8 at 5 minutes. He continued to demonstrate increased work of breathing and was intubated in the delivery room. He was admitted to the neonatal intensive care unit (NICU) for prematurity and respiratory distress. His birthweight was 1,589 g, which was appropriate for gestational age. Thirty minutes after birth, the patient had worsening tachypnea and subcostal retractions; chest radiograph at this time demonstrated diffuse bilateral reticular granular densities and microatelectasis CXR 1 . Oxygen saturation in room air was 78%. When 100% oxygen was administered, the oxygen saturation increased to 92%. Arterial blood gas (ABG) revealed: What is the appropriate treatment of this infant at this time? On arrival to the NICU, the patient was intubated and placed on mechanical ventilation. An echocardiogram revealed normal cardiac structure and function. The blood lactate level was elevated at 225.2 mg/dL (25 mmol/L). Blood ammonia concentration also was elevated at 518 mmol/L. Ketones were noted in the urine. ### Vital Signs Were: ### Physical Examination