Case 3: Term Neonate with Tachycardia

Abstract

A male infant is born at 39 weeks to a 27-year-old, gravida 3, para 1, blood group B–negative woman with an uneventful antenatal period and good antenatal care. The birth was via emergency lower-segment cesarean delivery, in view of breech presentation during labor and a birthweight of 3,100 g (appropriate for gestational age). The infant is born with no respiratory effort and bradycardia at birth requiring positive pressure ventilation. He is noticed to have micrognathia and glossoptosis causing airway obstruction and respiratory distress, with associated cleft palate (Figs 1 and 2), suggestive of Pierre Robin sequence. The infant’s 1-minute Apgar score is 4, and he develops stridor and respiratory distress soon after birth. A nasopharyngeal airway is inserted to relieve the respiratory distress. His 5-minute Apgar score improves to 7, and he is moved to the NICU for observation. He has no other obvious congenital anomaly. His chest radiograph is essentially normal. Approximately 1 hour after birth, he starts having tachycardia, with a heart rate of about 250 beats/minute, and …