Approach to complications of prematurity (early) Quiz: Ace Your Exams
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A 2-day-old newborn female delivered at 32 weeks’ gestation is in the Neonatal Intensive Care Unit (NICU) and being evaluated for multiple episodes of witnessed apnea lasting 20 to 30 seconds each. Parents are consanguineous (distant cousins), and pregnancy was complicated by maternal gestational diabetes. The infant was delivered via C-section for non-reassuring fetal heart rate, and delivery was uneventful. Due to prematurity, the infant is currently receiving intravenous ampicillin and gentamicin while awaiting blood culture results. The patient is also receiving nutrition through a nasogastric tube. There are no fevers, seizures, gastric residuals, or abnormal stools. Temperature is 37°C (98.6°F) and stable, pulse is 168/min, respirations are 35/min, blood pressure is 55/28 mm Hg, and oxygen saturation is 98% on two liters nasal cannula with 28% FiO2. On examination, no dysmorphic features are noted. The anterior fontanelle is open and flat. Nasogastric tube and umbilical lines are in place. Auscultation of the lungs reveals good air entry bilaterally. Heart sounds are normal with no murmur or cyanosis. The abdominal exam is unremarkable. Labs are shown below. Abdominal and chest X-rays are normal. Which of the following is the greatest risk factor for apnea in this patient?
| Laboratory value | Results |
| Hemoglobin | 15 g/dL |
| Hematocrit | 45% |
| White blood cells | 8,000/mm3 |
| Platelets | 290,000/mm3 |
| Sodium | 137 mEq/L |
| Potassium | 4 mEq/L |
| Blood glucose | 55 mg/dL |
| PH | 7.39 |
| PCO2 | 40 mmHg |
| Bicarbonate (HCO3) | 22 mEq/L |
| Blood culture | No growth to date |
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