Index of Suspicion in the Nursery

At 36 weeks’ gestation, a male infant is born to a healthy, gravida 2, para 1 mother. Other than the slightly preterm onset of labor, the pregnancy had a normal course. Labor and delivery were uncomplicated, with normal fetal heart rate monitoring results. The newborn appears in a good condition. Immediately after birth, he is put under a warmer, his skin is dried gently with warm towels, and his mouth and nose are suctioned gently. The infant never stops crying vigorously and is given an Apgar score of 10 at both 1 and 5 minutes. At the initial physical examination, the infant appears pink, is breathing normally, and has normal heart sounds. Femoral pulses are symmetric. After intramuscular injection of vitamin K and ophthalmic prophylaxis, he is put into an incubator for further stabilization and observation. After 30 minutes, the nurse calls the neonatologist because the boy has begun to demonstrate mild grunting, although he still looks pink, despite mild …