A full-term female infant is delivered at 39 weeks’ gestation by a 21-year-old gravida 4, para 3 woman with limited prenatal care. She is born via precipitous vaginal delivery at a local urgent care center with rupture of membranes less than 1 hour before delivery. Maternal group B Streptococcus status is unknown, and a drug screen is positive for tetrahydrocannabinol. The neonate's birthweight is 3,238 g, appropriate for gestational age, and Apgar scores are 8 and 8 at 1 and 5 minutes, respectively. She is transferred to a nearby level II nursery for further evaluation and care. She is initially well-appearing but uncoordinated with breastfeeding. At 11 hours after birth, she develops nonbloody, nonbilious emesis and respiratory distress.

On examination, she is ill-appearing with intermittent grunting, lethargy, subcostal and intercostal retractions, and hypothermia. A sepsis evaluation is conducted and the complete blood cell count is normal. A urinalysis is performed...

You do not currently have access to this content.