Assignment task: A 28 year-old primigravid mother delivered a baby boy, 37 weeks by last menstrual period, via emergency Cesarean section due to a non-reassuring trace. She had regular pre-natal check-ups, and no known co-morbidities. Her membranes were ruptured for approximately 12 hours prior to delivery. She had no fever, no vaginal discharge, and the amniotic fluid was non-foul smelling.
The infant was delivered meconium-stained, crying, with good tone. He was thoroughly dried, and was cleared to remain on skin-to-skin contact with his mother. On the fifth minute of life, he was noted to have alar flaring and grunting, accompanied intercostal retractions. The patient was promptly transferred to the warmer for further assessment, and provided O2 support via nasal cannula.
At the 10th minute of life, physical examination showed the following:
- Awake, on O2 support via nasal cannula at 1-2 lpm
- HR 150, RR 58, Temp 37.1 degrees Celsius, O2 saturations at 90-92%
- Pink conjunctivae, anicteric sclerae, (-) alar flaring or grunting, moist oral mucosa, open and flat anterior fontanelle
- Equal chest expansion, (+) occasional intercostal retractions, clear breath sounds, no rales/crackles/wheezes
- Adynamic precordium, distinct heart sounds, normal rate and regular rhythm, no murmurs
- Soft, globular abdomen, no palpable masses, stained umbilical cord with 2 arteries and 1 vein
- Full and equal pulses, (-) cyanosis, no rashes, (-) jaundice, (+) meconium-stained nails
1. What is your diagnosis?
2. Discuss the pathophysiology of your primary diagnosis for this case