Case 3: Recurrent Apnea and Cyanosis in an 11-Day-Old Infant

Abstract

A preterm (28 weeks of gestation) male infant develops recurrent episodes of apnea and severe cyanosis on day 11 after birth. The infant is born to a 39-year-old, gravida 4, para 3, living 3 mother by emergency caesarian section because of pathologic results of a nonstress test. The mother received a course of antenatal corticosteroids 12 hours before delivery. The antenatal period had been uncomplicated with normal results of fetal imaging targeted for anomalies. There are no antenatal risk factors for sepsis. Previous pregnancies were uneventful. The infant cries immediately after birth and has Apgar scores of 7, 8, and 8 at 1, 5, and 10 minutes, respectively. The infant weighs 1,080 g at birth and has respiratory distress syndrome for which he receives surfactant and continuous positive airway pressure (CPAP) for 4 days. On day 1, he is given parenteral nutrition and minimal enteral nutrition. Feeds are gradually increased, and he reaches full feeds by age 7 days. After the central catheters are removed, the infant is moved to the step-down nursery. The infant is feeding well with no sign of feeding intolerance or sepsis. On the 11th day, the infant has recurrent episodes of apnea initially requiring bag and mask, then CPAP, and finally mechanical ventilation. On examination, the infant is euthermic and has a heart rate of 175 beats per minute, a respiratory rate of 70 breaths per minute, prolonged capillary refill time (approximately 5 seconds), good pulse volume, moderate to severe intercostal and subcostal retractions, central and peripheral cyanosis, oxygen …