A 40-week female term infant was bom to a 20-year-old primagravida. Complications during pregnancy included a two-vessel cord noted on prenatal ultrasound, trichomonas infection (treated during pregnancy) and a positive Group-B streptococcus status (treated prior to deliver)'). The infant was delivered by Cesarean section due to failure to progress. Apgar scores were 8 and 9 at 1 and 5 min, respectively. During the initial exam in the delivery room, the infant was noted to have an imperforate anus and the two-vessel cord was verified. An attempt was made to place a nasogastric (NG) tube, but it was very difficult to insert due to resistance. It was left at 10 cm and the infant was transferred to a tertiary medical center for further evaluation and care.On admission, the infant had increased work of breathing including tachypnea, nasal flaring and retractions. On the initial chest radiograph, the NG tube was not seen even though it was in the left nare at 10 cm. The NG tube was removed and an orogastric tube was placed. The subsequent radiograph showed the tube in proper placement with the tip in the stomach. After removal of the NG tube, the work of breathing improved significantly.
展开▼
