After an otherwise normal pregnancy, a male infant was born at 37 weeks gestational age via emergency cesarean delivery for decreased or absent fetal movement with multiple late and variable heart rate decelerations. Rupture of membranes occurred at delivery with copious thick meconium. The baby was limp and apneic, requiring intubation and tracheal suctioning for meconium aspiration and respiratory support immediately after birth.
The infant’s APGAR scores were 4, 6, and 8 at 1, 5, and 10 minutes. Cord blood gas was unavailable but initial arterial blood gas was pH 7.28, CO2 44. He developed worsening respiratory distress and was transferred to the neonatal intensive care unit (NICU).
The mother was a 28-year-old G3P2002, previously healthy female with gestational diabetes controlled on glyburide. Prenatal screening tests were unremarkable including Group B Streptococcus (GBS) culture obtained at delivery that was negative. The mother denied tobacco, alcohol, or illicit drug use. She had no infections or complications during her pregnancy. She had no known foreign travel history or exposures to uncooked food, and the only cheese she had consumed was processed cheese out of a can. After delivery, the mother developed a fever from presumed chorioamnionitis. She received a course of antibiotics, improved, and was discharged to home.