A 3520-g boy was delivered at 39 weeks' gestation to a 27-year-old gravida 1 mother. The pregnancy was unremarkable, and membranes ruptured 14 hours before delivery. Attendance of a neonatologist was requested because of persistent fetal tachycardia and potential delivery via cesarean section. After administration of epidural anesthesia, the infant was delivered with forceps assistance. The umbilical cord blood was pH 7.22. At delivery, the infant was apneic and hypotonic and had poor perfusion. Bag and mask ventilation was begun, and Apgar scores were 1 and 7 at ages 1 and 5 minutes, respectively. A loud heart murmur was present. Results of the initial physical examination were pertinent for a mildly tachypneic, vigorous, full-term infant with no dysmorphic features. He had mild acrocyanosis. The precordium was hyperdynamic. A grade 2/6 (systolic) ejection heart murmur was present, and there was a gallop rhythm. The liver was palpable 2 cm below the
Ginsberg HG, Coulon RA, Culpepper WS, Wood BP. Radiological Case of the Month. Am J Dis Child. 1992;146(3):349–350. doi:10.1001/archpedi.1992.02160150089028
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