Baby James was born via a normal spontaneous vaginal delivery at 36 weeks gestation in a small community hospital. The mother arrived at the emergency room at 9 cm, 100% effaced, reporting ruptured membranes for 22 hours. Baby's fetal heart tones were 170 bpm. The mother delivered in the emergency room 30 minutes after being examined. This is her seventh pregnancy and she did not have prenatal care. Baby James was admitted to the observation nursery from the emergency room where he was born.

He weighed 5 lbs and was 19 inches long. His APGARS were 6 at one minute and 8 at 5 minutes. He has acrocyanosis and his initial glucose at 30 minutes of age was 35 and vital signs were HR 150, RR 76 temp 97.2 (axillary). The nurse noted nasal flaring, grunting and coarse breath sounds. His skin and nasal pharynx were cultured and he was observed on a radiant warmer that was skin temperature controlled.

1. Plot this baby's height and weight. Is this baby AGA, SGA or LGA? What is normal range for weight? For length?
2. List the signs of respiratory distress exhibited by this infant after birth?
3. Are James' vital signs a concern at 30 minutes of age? Why, or why not?
4. How significant is acrocyanosis for James?
5. What factors initiate respirations in the newborn at delivery?
6. What is surfactant and what is the significance of it? How is fetal lung maturity determined?

You are caring for Baby James at two hours of age his blood glucose was 40 and his nasal flaring continued, his RR was 100 and irregular with continued coarse breath sounds. He continues to exhibit acrocyanosis and

now displays circumoral cyanosis, nasal flaring and grunting with sternal retractions, and his temp is 96.8. A CBCD and blood cultures are sent and an IV started. James is being treated for TTN with oxygen and a warm environment.

1. What do you think might have been done differently for this delivery had the mother come in when she was at 4-6 cm instead of 9cm?
2. What is the most likely reason for this baby's initial hypoglycemia?
3. List risk factors that existed for infection?
4. Why is this baby hypothermic, and how does if affect this baby's transition.
5. This baby started displaying signs of jaundice at 6 hours of age. What is the significance of jaundice in a six hour old infant?