A 3-Day-Old Boy Is Evaluated in the Neonatal Intensive Care

A 3-day-old boy is evaluated in the neonatal intensive care unit for intermittent episodes of bradycardia and desaturation for the past 12 hours.  He was born at 29 weeks gestation and had a birth weight of 1,050 g (2 lb 5 oz) .  The patient had respiratory distress syndrome initially, for which he was intubated and given endotracheal surfactant therapy.  He was then extubated to continuous positive airway pressure on day of life 1 and has been stable since.  Antibiotics were discontinued at age 36 hours when cultures remained sterile.  During examination, the patient has cessation of respiratory effort that lasts about 25 seconds.  The heart rate decreases to 85/min, and the oxygen saturation decreases to 72%.  The patient recovers spontaneously, and the vital signs normalize.  Physical examination after the episode is normal.  Chest x-ray reveals resolving granular opacities bilaterally.  Which of the following is the best next step in management of this patient?

A) Albuterol
B) Caffeine
C) Dexamethasone
D) Intubation and mechanical ventilation
E) Restart antibiotics

Correct Answer:

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