An 830-g boy was born to a 17-year-old, primigravida mother after 27 weeks' gestation. At the time of delivery, he had no spontaneous respirations and was admitted to the Newborn Intensive Care Unit, Ochsner Clinic, New Orleans. He was intubated, and ventilation therapy was begun by bag; Apgar scores were 4 and 6 at one and five minutes. Severe respiratory distress was present with grunting, intercostal retractions, and decreased breath sounds bilaterally. The chest roentgenograms (Fig 1) were obtained at that time.
The infant was placed under a radiant warmer, and positive pressure ventilation therapy was begun with a respiratory rate of 16 per minute, a pressure of 20 cm H2O, and a forced inspiratory oxygen of 75%. His condition remained relatively stable over the first 48 hours. However, respiratory distress continued to worsen, and he required increased respirator support. At 3 days of age, he became severely