A 2220-g female infant was born at 35 weeks' gestation to a healthy 28-year-old mother. The pregnancy was uneventful. Membranes were ruptured three hours before spontaneous vertex vaginal delivery, and there was no evidence of fetal distress.
At birth the infant was active, with normal color, but respiratory distress with tracheal tug and strong inspiratory and expiratory efforts with chest retractions developed rapidly. There was no stridor, and no voice was heard when the infant cried.
In view of the severe respiratory distress, with a high partial arterial carbon dioxide tension of 78 mm Hg, intubation was attempted with size 3 and then size 2.5 endotracheal tubes. The vocal cords were visualized, but it was not possible to pass the endotracheal tube beyond the larynx. Gasping respirations developed, and the baby became apneic. Her chest did not expand when positive pressure was applied with a well-fitting mask and anesthetic bag.