A 2,640-g, male infant was delivered vaginally following a 36-week gestation. The pregnancy was complicated by severe preeclampsia. Labor was premature in onset and protracted, totaling over 19 hours. Apgar scores were 6 and 8 at one and five minutes, respectively.
The infant developed tachypnea, retractions, and grunting soon after birth. He was cyanotic and had diffuse rhonchi in both lungs, but was otherwise normal. Initial arterial blood-gas analyses demonstrated mild hypoxemia in room air, which was corrected with supplemental oxygen. Chest roentgenograms (Fig 1) were obtained 30 minutes after birth. The hematocrit value was 40% and serum total protein levels were 5.9 g/dL; results of routine laboratory tests were otherwise normal. A sepsis workup was performed and the infant was treated with antibiotics.
Six hours after birth the infant had developed an increasing oxygen requirement and respiratory acidosis. Positive pressure ventilation was initiated with good effect. Another chest roentgenogram