Abnormal Lung Pattern in a Newborn

T he patient was the 3.0 kg product of a 38-week gestation of a 27-year-old gravida 1 para 0 woman receiving phenobarbital, 60 mg po, daily for seizure control. Physical examination revealed a cyanotic, lethargic newborn with a heart rate of 120 per minute, respiratory rate of 80 per minute, and a systolic blood pressure of 40 mm Hg in all extremities. There were r#{224}les over both lung fields. Breath sounds were better heard on the right. There was no heart murmur; the second heart sound was single. The liver was palpable 1 cm below the right costal margin. Peripheral pulses were diminished but equal. The electrocardiogram demonstrated right axis deviation and right ventricular predominance. Umbilical artery gases in 40 percent oxygen