A newborn female with 3200 g delivered via normal spontaneous vaginal delivery to a 25 year old G1P0 syphilis non-reactive, group B strep (GBS) negative, rubella immune, hepatitis B surface antigen negative mother with early preeclampsia and thrombocytopenia (platelet count 80,000). Rupture of membranes occurred 11 hours prior to delivery with clear fluid. Intrapartum medications included 3 doses of butorphanol (narcotic opioid analgesic). The last dose was administered within 1 hr of delivery. There was no maternal fever. Apgars were 8 and 9. In the newborn nursery, vital signs are: HR 140, T 37, BP 47/39, RR 54.
Oxygen saturation is 98-100% in room air. The infant appears slightly pale and mottled. She is centrally pink with persistent grunting, shallow respirations, and lethargy. Her fontanelle is soft and flat. Heart exam is normal. Lungs show good aeration. Abdomen…
