Dr. Kamran Afsharian- Specialist Neonatologist | IMH

IMH Case Of the Week – Severe RDS with severe septic shock in a term infant of a diabetic mother

 05 April 2024

Dr. Kamran Afsharian

Specialist Neonatologist

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Admission History:

A Baby girl with a birth weight of 2830 grams Appropriate for GestationaIAge(AGA) was admitted to the Neonatal Intensive Care Unit (NICU) immediately after birth due to presenting as limp and without effective breathing. The delivery, via LSCS, was necessitated by breech presentation and a previous Cesarean Section. Upon admission to the NICU, the infant was promptly resuscitated and intubated in the operating theater, followed by mechanical ventilation to support breathing.


Upon assessment in the NICU, the patient was diagnosed with severe respiratory distress syndrome (RDS) compounded by severe sepsis and shock. This diagnosis was made evident by the presentation of desaturation, gasping, and bradycardia, necessitating cardiopulmonary resuscitation (CPR). Further investigation revealed the need for vasoactive medications, intravenous fluids, and a single dose of Survanta administered via endotracheal tube (ETT)

to manage the severe RDS. Additionally, broad-spectrum antibiotics were initiated to address the underlying septicemia.


The clinical course of this case underscores the challenges associated with managing neonates with multiple concurrent morbidities, including RDS, sepsis, and shock. Prompt and coordinated intervention, including mechanical ventilation, resuscitation measures, vasoactive support, and antibiotic therapy, was crucial in stabilizing the patient’s condition. The successful transition from mechanical ventilation to non-invasive respiratory support modalities, such as nasal continuous positive airway pressure (NCPAP) and high-flow nasal cannula (HFNC), reflects the effectiveness of the multidisciplinary approach adopted in the NICU.


After a comprehensive course of treatment spanning several days, the patient has demonstrated significant improvement in respiratory function, hemodynamic stability, and overall clinical status. With the successful weaning from respiratory support and achievement of full oral feeding, the baby girl is now discharged from the NICU. Continued monitoring and follow-up care will be essential to ensure ongoing health and development in the post-discharge period.

Dr. Kamran Afsharian
Specialist Neonatologist