Approach to respiratory distress (newborn) Quiz: Ace Your Exams

A newborn boy is delivered via vaginal delivery at 28 weeks gestation because of preterm labor. There is no maternal fever and GBS is negative. The newborn weighs 1500-g (3.3 lbs). Apgar scores are 2 and 6 at 1 and 5 minutes, respectively. He requires continuous positive airway pressure (CPAP) immediately after delivery for respiratory distress. In the NICU, temperature is 36.8°C ( 98.2°F), pulse is 175 beats/min, and respiratory rate is 78/min with SpO₂ 70% on supplemental oxygen at FiO₂ 100%. On physical examination, the patient has subcostal retractions, grunting, and nasal flaring. Auscultation reveals decreased air entry in the bilateral lung fields throughout. Chest x-ray is shown below. Which of the following is the best next step in management?
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