Case 2: Newborn with Acute-Onset Central Cyanosis

Abstract

A female infant of 31 weeks’ gestational age and birthweight of 1.19 kg is born to a gravida 2 woman. The mother had received a complete course of antenatal steroids 2 days before delivery. There is no history of early infantile deaths, early-onset stroke, or coronary heart disease in any of the family members. The infant is delivered via cesarean section for fetal bradycardia and maternal eclampsia. At birth, she requires resuscitation with bag and mask for 1 minute, which is followed by delivery room continuous positive airway pressure (CPAP). Respiratory distress in the immediate neonatal period is supported with bubble CPAP in the first 48 hours after birth. For hemodynamically significant patent ductus arteriosus (PDA), the newborn is treated with diuretics, inotropes, and then ibuprofen syrup from day 3 to day 6 after birth. Echocardiography performed on day 6 after birth shows a closed PDA and no structural heart defect or vegetation. On day 8 after birth, in view of recurrent apneas, positive sepsis screen, and a positive blood culture for coagulase-negative Staphylococcus , the infant is given intravenous vancomycin. Her general condition is improving; she is tolerating feeds and is being transferred to a stepdown unit. On day 14 after birth, the infant develops repeated desaturations, which progress to recurrent apnea over the duration of 12 hours. She continues to require an increasing fraction of inspired oxygen (FiO2), bubble CPAP, and then ventilation with 100% FiO2. On examination, the infant …