Galvanised by a respiratory distress diagnosis

The third pregnancy of a 38-year old Caucasian G3P2 woman had been unremarkable apart from pregnancy-induced cholestasis and group B streptococcus (GBS) detected on a routine 35-week high vaginal swab and for which intrapartum penicillin was administered. Following induction of labour at 38 weeks' gestation for worsening cholestasis, the woman proceeded to a normal vaginal delivery of a live male infant. There was no maternal pyrexia and the liquor was clear. The parents were non-consanguineous and neither the parents nor the other siblings had a history of pulmonary disease. The baby was born with Apgar scores of 8 and 9 at 1 and 5 min, respectively. He developed respiratory distress almost immediately, with an audible grunt, flaring of the alae nasi and tachypnoea. Oxyhaemoglobin saturation (SpO(2)) was 82% when breathing room air so the infant was placed in a head box (HB) with fractional inspired oxygen (FiO(2)) of 40% to maintain SpO(2) >95%. A chest x ray (CXR) showed a coarse reticular-granular pattern appearance, fluid in the right horizontal fissure and low lung volume. Blood cultures were collected and empirical antibiotics (amoxycillin and gentamicin) were started. Capillary blood gas analysis at this stage showed: pH 7.26, pCO(2) 61, pO(2) 32, BE 0.7. Over the next 3 h, oxygen requirement decreased to FiO(2) 32%, but the infant remained tachypnoeic.