| Popis: |
A late-preterm female infant is born at 36 weeks’ gestation via spontaneous vaginal delivery to a 27-year-old, gravida 1, now para 1 mother whose pregnancy is complicated by polyhydramnios and preterm prolonged rupture of membranes. The infant has poor tone, no respiratory effort, a heart rate less than 100 beats per minute, and craniofacial abnormalities. The infant receives positive pressure ventilation and chest compressions with unsuccessful attempts at intubation by the pediatrician at 4 minutes of age. Heart rate is unresponsive to positive pressure ventilation. Laryngeal mask airway (LMA) is placed at 7 minutes of age after several unsuccessful endotracheal intubation attempts by anesthesiologists. Heart rate improves after placement of the LMA to more than 100 beats per minute. Apgar scores are 1 at 1 minute, 1 at 5 minutes, 2 at 10 minutes, 5 at 15 minutes, 6 at 20 minutes, and 7 at 25 minutes. A peripheral intravenous cannula is inserted, and a 10-mL/kg dose of normal saline bolus is given. Blood culture is performed, and arrangements are made for transfer to a tertiary care neonatal intensive care unit (NICU). A capillary blood gas is performed before transport, which reveals the following: pH, 7.05; Pco2, 73 mm Hg; Po2, 58 mm Hg; bicarbonate, 20 mEq/L (20 mmol/L); and base deficit, −10 mEq/L (−10 mmol/L). The infant receives ventilatory support with an LMA in place until arrival of the transport team. Before transport, endotracheal intubation is attempted again by the transport team with a video laryngoscope and is unsuccessful, … |
