November 1997

Pathological Case of the Month

Author Affiliations

From the Sections of Neonatology (Drs Rehan, Fajardo, and Seshia) and Pediatric Pathology (Dr Phillips), Health Sciences Centre, Winnipeg, Manitoba.

Arch Pediatr Adolesc Med. 1997;151(11):1163-1164. doi:10.1001/archpedi.1997.02170480093016

THIS INFANT was born at 40 weeks' gestation to a 29-year-old gravida 2, para 0 white woman by vacuum delivery. Birth weight was 3770 g; crown-heel length, 56 cm; head circumference, 35.5 cm. Apgar scores were 7 and 7 at 1 and 5 minutes, respectively. Initial resuscitation included oropharyngeal suctioning and oxygen supplementation by face mask. Respiratory difficulty was soon noted. Ambient oxygen concentration was increased without benefit. At 1½ hours of age, he underwent intubation and ventilation. A chest radiograph showed bilateral pneumothoraces (Figure 1) that were drained through indwelling chest tubes with immediate improvement in oxygen saturation from 72% to 100%. Complete blood cell count, serum electrolyte level, and blood glucose level were normal. Arterial blood gas measurement showed pH, 7.45; PaO2, 73 mm Hg; PaCO2, 24 mm Hg; and bicarbonate, 17 mmol/L. Ventilatory rate ranged between 22 and 40/min; peak inspiratory pressure between 26 and

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