A 1-Hour-Old Boy Is Evaluated for Respiratory Distress

A 1-hour-old boy is evaluated for respiratory distress.  The patient was born at 39 weeks gestation via cesarean delivery.  The mother's pregnancy was complicated by gestational diabetes, and she was nonadherent with treatment.  Birth weight was at the 95th percentile.  Apgar scores were 5 and 7 at 1 and 5 minutes, respectively.  Temperature is 36.6 C (97.9 F) , pulse is 160/min, and respirations are 70/min.  Oxygen saturation is 94% on room air.  The patient is in mild respiratory distress with a plethoric appearance.  Cardiac examination reveals a 3/6 systolic ejection murmur.  Physical examination is otherwise unremarkable.  Bedside echocardiography shows increased thickness of the interventricular septal wall.  Which of the following is the best initial therapy for this patient?

A) Dobutamine
B) Furosemide
C) Indomethacin
D) Nitroprusside
E) Propranolol

Correct Answer:

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