A 41 week, 3.8 kg male infant is delivered via urgent c-sect…
Questions
A 41 week, 3.8 kg mаle infаnt is delivered viа urgent c-sectiоn thrоugh mecоnium stained amniotic fluid secondary to non-reassuring fetal heart tones. He is meconium stained at delivery. Apgars are 1, 2, 5 and 7 at 1, 5, 10 and 15 minutes of life. He is admitted to the NICU intubated in 100% FiO2 with pre-ductal saturations 80-85% and post-ductal saturations 65-75%. He is on conventional ventilation with the following settings: PIP 25 PEEP 6 Rate 50 and i-time 0.3. There are copious meconium stained ETT secretions. An umbilical arterial catheter is placed and the following ABG is obtained: 7.01/70/30/16/-10. The CXR shows adequate expansion to 8-9 ribs with coarse, patchy, irregular pulmonary densities with scattered areas of consolidation. Surfactant is given with minimal improvement in oxygenation. His pre and post ductal oximeter trends remain unchanged. A follow-up ABG is obtained 30 minutes after surfactant: 7.05/60/25/16/-10. Which of the following should you order next?