paeds792

paeds792

A baby born at 25 weeks gestation around 24 hours ago is reported to be in a critical state. Birth weight is 550g and the baby shows a poor respiratory effort. The membranes ruptured just prior to the delivery with no signs of maternal fever or sepsis. The infant received no antenatal steroids. After delivery, the neonate was subsequently intubated, resuscitated and given a dose of Curo surf. he was extubated onto CPAP within 6 hours. UVC and UAC access was established and benzylpenicillin and gentamicin were administered. Small amounts of maternal breast milk were given for mouthcare. The baby’s cardiovascular system was stable and early ABG samples were within acceptable ranges. At 24 hours of age the baby deteriorates with numerous desaturations and bradycardias requiring reintubation. First gas following reintubation shows pH 7.19, CO2 8.6 kPa, BE -10. Oxygen requirement is 60%. FBC is unremarkable. The baby is cool peripherally and central CRT is 3-4 seconds. There is a loud machinery murmur. Abdominal radiograph shows a football sign. What is the most likely cause of the baby’s deterioration?