The Blue Baby Blues: A Rare Case of Cyanosis in the Newborn

Abstract

HISTORY OF PRESENT ILLNESS J.S. was a full-term, large-f gestational-age boy born to a year-old gravida 2 para 1 mothe a referring hospital. His mother ceived appropriate prenatal car and the pregnancy was uncomp cated. Maternal laboratory tes were negative for rapid plasmin agin, hepatitis B surface antige and human immunodeficiency v rus and revealed that she was mune to Rubella; group B Streptococcus status was unknown. J. was delivered via spontaneo vaginal delivery 7 hours after r ture of membranes for clear am otic fluid. The delivery was complicated, with a reassurin fetal heart rate tracing througho At birth, the infant was found t cyanotic with poor respiratory fort. Bag and mask ventilation w administered but he did not prove and thus was intubated the delivery room. He did not quire chest compressions or medications because he maintained heart rate greater than 60 beats minute throughout the resuscit tion (Kattwinkel, 2006). Apgar scores were 5 and 6 at 1 a minutes of life. J.S. was transferred to the n natal intensive care unit (NIC immediately and placed on m chanical ventilation with 100% o ygen, and umbilical venous a arterial lines were inserted to propriate placement. Oxygen sat ration measurements (Sa O2) on admission were found to be in 50s, and his initial arterial blo gas (ABG) measurement was s nificant for a mixed respiratory metabolic acidosis (pH, 6.9 PaCO2,72 mmHg; Pa O2, 12 mmHg HCO3, 13 mEq/L; base defi 16). Over several hours, respi tory support was increased to m imal settings on conventional ve tilation and inhaled nitric oxi (iNO) was initiated at 20 parts million (ppm) without improv ment. Multiple normal saline (N solution boluses and doses of dium bicarbonate were admini tered with minimal improveme in blood pressure, Sa O2, or ABG measurements. Dopamine was in tiated and titrated up to 10 g/kg/