LAUSR

A 2.7-kg male neonate is delivered at 36 weeks’ gestation by a 33-year-old gravida 1, para 1 woman via cesarean section. The cesarean delivery was indicated for non-reassuring fetal heart tones and arrest in the first stage of labor. The mother’s pregnancy had been complicated by gestational diabetes (managed with metformin), chronic hypertension, and preeclampsia. The family history is not significant for any congenital cardiac defects or genetic syndromes. Fetal echocardiography suggested a coarctation of the aorta at 34 weeks of gestation. Fetal ultrasonography at 28 weeks’ and 34 weeks’ gestation did not show any anomalies. After an uncomplicated delivery (Apgar scores of 8 and 9 at 1 and 5 minutes, respectively), the infant develops mild respiratory distress, which requires continuous positive airway pressure (CPAP). He is admitted to the NICU for anticipatory screening for coarctation and management of his respiratory distress. Chest radiography performed 1 day after birth shows no significant signs of respiratory distress syndrome and normal chest anatomy, with no defects (Fig 1). His respiratory distress subsides within 1 day after birth and feeding is initiated on the same day. Postnatal evaluation, including 4 extremity blood pressure measurements, pre- and postductal saturations, and physical findings, are reassuring within the first 72 hours, though cardiac imaging is yet to be performed. Four days after birth, the neonate develops bilious emesis and respiratory distress, prompting reinitiation of …