Apnea In A Term Neonate: Expanding The Differential Diagnosis

A zero-day old female infant is admitted to the NICU for persistent oxygen desaturations and cyanosis. She was born at a gestational age of 39 weeks to a 31-year-old Gravida 4 Para 4 mother by spontaneous vaginal delivery. The pregnancy was uncomplicated. Maternal blood type was O positive and the remainder of the maternal serologies are unremarkable. Delivery was complicated by the presence of meconium stained fluid and a tight nuchal cord. APGAR scores were six at one minute and eight at five minutes. The infant required administration of CPAP in the delivery room for an oxygen saturation of seventy percent at five minutes of life. Following admission to the NICU, the infant had an escalating oxygen requirement and recurrent apneic events resulting in endotracheal intubation and mechanical ventilation.