Case 2: Unusual Cause of Abdominal Distention and Abdominal Wall Erythema in a Preterm Infant

Abstract

A female infant is born at 24 weeks’ gestational age via normal spontaneous vaginal delivery to a 36-year-old gravida 5, para 2+2+0 woman with no known medical problems. The pregnancy is uncomplicated, and prenatal laboratory results and her fetal survey are all unremarkable. The mother presents at 24 weeks with spontaneous rupture of membranes and she receives 1 dose of dexamethasone just before delivery. Apgar scores are 3 and 8 at 1 and 5 minutes, respectively. The infant undergoes immediate intubation within the first minutes after birth; because of respiratory distress, she receives 1 dose of surfactant replacement therapy through the endotracheal tube and is transferred to the NICU in a portable ventilator after initial stabilization. Initial newborn examination findings are within normal parameters. The infant is born with a birthweight of 620 g, head circumference of 22 cm, and length of 32 cm, with all measurements plotted to be appropriate for gestational age. An umbilical arterial catheter and umbilical venous catheter are inserted, partial sepsis evaluation undertaken, and antibiotic treatment started. The infant is maintained on endotracheal intubation and mechanical ventilation on volume control–assist control mode, with volume guarantee of 2.8 mL, maximum ventilation pressure 20 cm H2O, positive end expiratory pressure 6 cm H2O, inspiratory time 0.3 seconds, and heart rate 60 beats/min. She is given a second dose of surfactant …