A 2-Hour-Old Boy Is Admitted to the Neonatal Intensive Care

A 2-hour-old boy is admitted to the neonatal intensive care unit with severe respiratory distress.  The patient was born via forceps-assisted vaginal delivery at 38 weeks gestation to a 35-year-old woman, gravida 2 para 2, whose pregnancy was complicated by poorly controlled gestational diabetes mellitus.  The delivery was complicated by recurrent late decelerations and thick meconium.  The patient was intubated in the delivery room due to respiratory distress.  Blood pressure is 58/30 mm Hg, pulse is 158/min, and respirations are 70/min.  Pulse oximetry readings are 90% in the right hand and 79% in the right foot on 100% oxygen.  Physical examination is remarkable for meconium-stained nails and intercostal and subxiphoid retractions.  Chest x-ray reveals bilateral, patchy opacities and hyperinflation consistent with meconium aspiration syndrome.  Echocardiogram shows decreased right ventricular output.  Which of the following is the best next step in management of this patient?

A) Albuterol
B) Hydrochlorothiazide
C) Ibuprofen
D) Nitric oxide
E) Vecuronium

Correct Answer:

Verified

Unlock this answer now
Get Access to more Verified Answers free of charge

Access For Free