Approach to cyanosis (newborn) Quiz: Ace Your Exams
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A newborn boy is delivered at 37 weeks of estimated gestational age via cesarean delivery due to breech presentation. The newborn is cyanotic immediately after delivery. The pregnancy was uncomplicated, and the mother had regular prenatal checks. Membranes ruptured two hours prior to delivery, group B streptococcus (GBS) is negative, and amniotic fluid is clear. The patient weighs 3900-gms. APGAR scores are 4 and 6 at 1 and 5 minutes, respectively. At delivery, the infant's neck was stretched due to the abnormal presentation. Temperature is 37°C (98.6°F) and stable, pulse is 188/min, respirations are 85/min, blood pressure is 67/41 mmHg, and oxygen saturation is 90% on room air in the right hand and foot. Physical exam does not show dysmorphic features but reveals cyanotic moist mucous membranes. There is stridor, and the patient has a hoarse cry. Nasal flaring and intercostal retractions are noted. Pulses are equal bilaterally. There is decreased air entry bilaterally on pulmonary examinations. Cardiac exam is significant for normal S1 and S2 without murmurs. The abdomen is soft without hepatosplenomegaly. Chest X-ray is normal. The patient is intubated and placed on mechanical ventilation with improvement of cyanosis and respiratory distress. Which of the following is the most likely diagnosis?
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