About 30 minutes ago, a 3.5-kg male infant was born prematur…

About 30 minutes ago, a 3.5-kg male infant was born prematurely. The footling breech presentation was delivered at term by cesarean section after 24 hours of labor. He is currently in the neonatal intensive care unit receiving blow-by O2. His respiratory rate ranges from about 67 to 83 breaths/min, he has a Silverman-Andersen score of 7, and his fingers and toes have a blue tinge. Periodically, he shows mild retractions. What steps would you take in the respiratory care of this infant?

A 1-month-old prematurely born baby boy with a diagnosis of…

A 1-month-old prematurely born baby boy with a diagnosis of respiratory syncytial virus (RSV) pneumonia is receiving PC-CMV. The patient’s initial measured VT was about 5 mL/kg with a respiratory rate of 40 to 60 breaths/min, the SpO2 was 95% on an FIO2 of 0.3, and  was 0.28 L. Over several hours, VT diminishes to about 2 to 3 mL/kg and the respiratory rate increases to over 100 breaths/min. The SpO2 decreases to about 92%, but the  remains unchanged. What change in ventilator settings is necessary for this patient?

You are called to assist with a full-term neonate who was tr…

You are called to assist with a full-term neonate who was transferred to your facility for further evaluation. The patient is the son of a diabetic mother who tested positive for group B streptococcus infection. He is 4 kg, has received one dose of surfactant, and has extremely low lung volumes on AP chest radiograph. The transport team has the infant on continuous mandatory ventilation (CMV), pressure control rate of 60, peak inspiratory pressure (PIP) of 32, positive end-expiratory pressure (PEEP) of 8, and fraction of inspired oxygen (FiO 2) of 1.0. These ventilator settings are producing a peripheral capillary oxygen saturation (SPO 2) of 85%, with admission blood gas values of 7.15/65/66/23. What mode of ventilation would you suggest for this patient and why?