Case 1: A Term Infant with Respiratory Distress

A 38-week, 2,800-g male neonate is born to a gravida 2, para 1 mother with an uneventful antenatal period; the neonate is born via normal vaginal delivery. After a normal transition, he is transferred to the mother’s room and begins exclusive breastfeeding. Around 24 hours after birth, in the postnatal ward, the neonate is noted to have tachypnea with poor peripheral pulses and prolonged capillary refill time. Considering the possibility of early-onset sepsis with shock, a 10 mL/kg normal saline bolus is given over 30 minutes and the neonate is transferred to the NICU. Further evaluation shows a respiratory rate of 72 breaths/min, mild intercostal retractions, and heart rate of 150 beats/min, with feeble peripheral pulses and a capillary refill time of 4 seconds. No pallor, icterus, or petechiae are noted, and the cry, tone, and activity of the neonate are normal. The neonate is given oxygen by hood at 3 L/min, intravenous fluids, and intravenous antibiotics. ### Progression/Diagnosis Cardiac examination reveals normal first and second heart sounds with a grade 3/6 systolic murmur in the aortic area. Chest radiography (Fig 1) reveals a normal heart size, …