An extremely preterm 5-week-old female infant requiring conventional mechanical ventilation and requires progressive escalation in ventilator settings to maintain adequate oxygenation and ventilation.

  • Born to a 25-year-old gravida 4, para 0-1-3-1, woman

  • Prenatal course: Uncomplicated

  • Prenatal maternal screening: Hepatitis B surface antigen negative, human immunodeficiency virus negative, rapid plasma reagin negative, rubella immune, chlamydia negative, gonorrhea negative, group B Streptococcus unknown

  • Estimated gestational age: 23 weeks

  • Preterm premature rupture of membranes and unstoppable labor leading to spontaneous vaginal delivery; bloody and meconium-stained amniotic fluid

  • Apgar score: 2 and 5 at 1 and 5 minutes, respectively

The female infant was dried, suctioned, intubated, given a dose of surfactant in the delivery room, and then placed on conventional mechanical ventilation in the NICU. An initial chest radiograph obtained on day 1 after birth is shown in Fig 1. Subsequently, she received 2 more doses of surfactant. She continued to require invasive...

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