Case 2: Respiratory Failure, Myocardial Dysfunction, and Pulmonary Hemorrhage in a Full-Term Newborn.

A male appropriate-for-gestational age infant is born at 39 6/7 weeks to a 25-year-old gravida 1, para 0, group B Streptococcus− negative woman at a community hospital via unremarkable spontaneous vaginal delivery. The prenatal history is significant only for a transient rash on the mother’s palms 1 to 2 weeks before delivery, which was associated with nausea and vomiting. All prenatal laboratory values are normal, and membranes rupture 5 hours before delivery, with clear fluid. The infant is born floppy and cyanotic, with no respiratory effort. He is dried and stimulated, and shows some improvement. His Apgar scores are 7 and 8 at 1 and 5 minutes, respectively. The pediatrics team is called shortly after delivery for persistent cyanosis, tachypnea, and grunting. The infant’s condition quickly progresses to apnea and bradycardia, which requires a prolonged resuscitation including intubation, chest compressions, and 2 doses of epinephrine. At 30 minutes, bright red blood is noted to be coming from the endotracheal tube. After stabilization, the infant is urgently transported to a tertiary care center for further management. On admission to the tertiary care center, physical examination reveals a pale, hypotonic, hypotensive infant with coarse breath sounds and minimal spontaneous movements. No organomegaly, skin lesions, or dysmorphic features are noted. Initial laboratory studies indicate that the …