Approach to complications of prematurity (early) Quiz: Ace Your Exams

A 1300-gram newborn male is delivered at 28 weeks’ gestation by spontaneous vaginal delivery. Apgars are four and seven at one and five minutes, respectively. Immediately after delivery, the newborn requires resuscitation and is placed on continuous positive airway pressure (CPAP) and then admitted to the Neonatal Intensive Care Unit (NICU). Before delivery, the pregnancy was uneventful with normal maternal labs. Rupture of the membranes was eight hours before delivery. The mother did not receive betamethasone before delivery. Temperature is 36.9°C (98.4°F) and stable, pulse is 168/min, respirations are 64/min, blood pressure is 48/25 mm Hg, and oxygen saturation is 90% on nasal CPAP with 0.4 FiO₂. On examination, the anterior fontanelle is open and flat. The infant is tachypneic with subcostal retractions, grunting, and nasal flaring. Auscultation reveals decreased air entry throughout the lung fields bilaterally. Heart sounds are normal, and no murmurs are heard. The abdominal exam is unremarkable. Umbilical lines are in place. The chest radiograph is shown below. Which of the following is the best next step in management?
 ^{Häggström et al. Reproduced from Wikipedia.  Licensed under CC0.}