Baby’s birth weight is 2,696 grams, and her Apgar score is 8 at 1 minute and 9 at 5 minutes. Screening labs were unremarkable. Mom is O positive. Baby is O negative and Coombs negative. There was meconium-stained liquor but no maternal fever or prolonged rupture of membranes. Infant had retractions, grunting, and nasal flaring soon after birth. Respiratory distress improved with NIPPV rate 20, pressures 20/6, FiO2 40%.

Of note, prenatal ultrasound at 28 weeks showed a possible 5.6-cm complex solid and cystic mass in the right side of the abdomen and pelvis.

• General Appearance: Healthy-appearing, vigorous infant; strong cry, well-perfused
• Head: Sutures mobile, fontanelles normal size
• Eyes: Sclerae white, pupils equal and reactive, red reflex normal bilaterally
• Throat: Lips, tongue, and mucosa are moist, pink, and intact; palate intact
• Neck: Supple, symmetrical
• Chest: Lungs clear to auscultation, respirations unlabored
• Heart: Regular rate and rhythm, S1 S2, no murmurs, rubs, or gallops
• Abdomen: Soft, nontender, no masses; umbilical stump clean and dry; no abdominal mass felt

Admission Labs:

• POC Glucose: 59; 40–125 mg/DL
• Hematocrit: 61 (H); 36%–48%
• Hemoglobin: 20.7 (HH); 12.0–16.0 g/dL
• pH Cap: 7.38; 3.30–7.45
• pCO2, Cap: 39.2; 35–45 mmHg

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Tanya Brown, MD, Pamela Botchway, MD, and Jacek Ubaka, MD
Department of Neonatology
John H. Stroger Hospital of Cook County
Chicago, IL