A pregnant woman at 37 weeks of gestation has had ruptured membranes for 26 hours.A cesarean section is performed for failure to progress.The fetal heart rate before birth is 180 beats/min with limited variability.At birth the newborn has Apgar scores of 6 and 7 at 1 and 5 minutes and is noted to be pale and tachypneic.Based on the maternal history,the cause of this newborn's distress is most likely:

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The prolonged rupture of membranes and the tachypnea (before and after birth)suggest sepsis.A differential diagnosis can be difficult because signs of sepsis are similar to noninfectious problems such as anemia and hypoglycemia.Phrenic nerve injury is usually the result of traction on the neck and arm during birth and is not applicable to this situation.The earliest signs of sepsis are characterized by lack of specificity (i.e.,lethargy,poor feeding,and irritability),not respiratory distress syndrome.

A Pregnant Woman at 37 Weeks of Gestation Has Had