LAUSR

A 15-day old female preterm infant who is tolerating advancing enteral feedings presents with sudden abdominal distension and erythema and edema of the anterior left side of the chest and abdomen. ### Prenatal and Birth Histories ### Presentation after Birth and Postnatal Course (Days 1–15) The neonatology team intubated the newborn in the delivery room, administered intratracheal surfactant, and weaned the infant to low ventilator settings with a fraction of inspired oxygen (FiO2) of 0.21. On arrival at the NICU, the team placed umbilical catheters. As a result of extensive bruising of the entire trunk after a difficult extraction, the neonate was placed under phototherapy. She received a second dose of surfactant at 12 hours of age and underwent extubation on the first day after birth. She needed reintubation on the third postnatal day and received a third dose of surfactant at that time. Six days after birth, the team reattempted extubation, but she had increased respiratory distress and required reintubation, followed by a fourth dose of surfactant. At that time, chest radiography showed pulmonary interstitial emphysema (PIE) and the infant was switched from conventional to high-frequency jet ventilation (HFJV). The PIE was noted to resolve on radiography by 12 days of age. The infant’s postnatal course was also notable for empiric treatment with ampicillin …