TEAM C SURVIVAL GUIDE: Answer to Question #8

8.       You are called to a delivery secondary to meconium for a 39³ G3 P2 serology negative, GBS +, HIV neg, healthy 32yo F.  The DR RN tells you that mom received 2g IV Ampicillin 6h ago, and 1g 2h ago.  The infant is delivered and brought to the radiant warmer where you suction, dry, and stimulate him following the NRP guidelines.  Your assessment is a healthy term male infant and as you are wrapping him, you notice he has some nasal flaring and is grunting, but has pink color throughout.  What should you do for this infant?  What are you concerned about?   

The clinical appearance of the infant suggests respiratory distress.  There are a number of factors which might be contributing to the distress including meconium aspiration, GBS pneumonia, or transient tachypnea of the newborn.  Mom has been appropriately chemoprophylaxed for her GBS status; however, you should consider a CBC and BCx in an infant born to a GBS+ mother who has clinical signs of infection (please see CDC website for current GBS guidelines).  You should be taking steps to ensure adequate oxygenation in this infant.  This patient should be brought back to the NICU for observation.  An SpO2 +/- ABG is indicated here.  SpO2 in the low 90’s should not be tolerated in term infants as they are at risk for developing PPHN (Persistent Pulmonary Hypertension). These infants should be treated with supplemental oxygen (BBO2/Nasal Cannula/CPAP/intubation) as clinically indicated.  If the clinical scenario warrants, a CXR should be obtained.   Please see reading materials for details re: the evaluation and treatment of such infants.