An Infant with Severe Stridor and Cyanosis at Birth

A male infant born via vaginal delivery presents with biphasic stridor, cyanosis, tachypnea, chest retractions, and copious secretions since birth. ### Prenatal and Birth Histories ### Presentation After birth, the infant was noted to have increased work of breathing, severe biphasic stridor, and cyanosis. He was briefly given positive pressure ventilation for apnea, and was then administered CPAP with a fraction of inspired oxygen (Fio2) of 100%. Multiple attempts at intubation were unsuccessful; a laryngeal mask airway placement was not attempted. The infant was subsequently given high-flow nasal cannula at 3 L/min with an Fio2 of 1 and transported to the NICU at a tertiary hospital. The infant continued to have stridor with significant increased work of breathing, but saturations remained 85% or greater on 3 L/min and an Fio2 of 1. Before transport, a capillary blood gas showed a pH of 7.08 and Pco2 of 89 mm Hg (12 kPa); a chest radiograph was concerning for bibasilar pneumothoraces. ### Vital Signs ### Physical Examination (4 Hours after Birth)