A pregnant woman at 37 weeks’ gestation has had ruptured membranes for 38 hours. A cesarean is performed for failure to progress. FHR baseline before birth was 180 BPM with marked variability. At birth, the newborn had Apgar scores of 6 and 7 at one and five minutes and is now noted to be pale and tachypneic. Based on the maternal history, what is the most likely cause of this newborn’s distress?

Choice A rationale

Advising about birth defects without offering compassionate support can intensify parental grief and fails to acknowledge the significance of their emotional trauma, worsening their psychological response after a stillbirth.

Choice B rationale

Discouraging naming deters parental acknowledgment of their baby's existence, which disrupts grieving processes. Recognizing their loss helps families process grief healthily and facilitates emotional closure.

Choice C rationale

Giving mementos and allowing holding the baby fosters parental bonding and validates their loss. These actions are supported by bereavement care guidelines promoting emotional processing, acceptance, and closure after stillbirth.

Choice D rationale

Immediate morgue transport disregards the psychological needs of grieving parents and deprives them of opportunities to spend time with their baby, essential for acknowledging their loss and beginning grief processing.

Choice A rationale

Hypoxia may contribute to tachypnea and distress, but it is unlikely the primary cause, as baseline fetal heart rate of 180 BPM indicates infection-related stress rather than isolated oxygen deprivation.

Choice B rationale

Respiratory distress syndrome predominantly affects preterm infants due to surfactant deficiency. At 37 weeks’ gestation, surfactant levels should be adequate, making this an unlikely cause of the newborn’s tachypnea and pallor.

Choice C rationale

Prolonged rupture of membranes increases the risk of neonatal sepsis. Signs such as tachypnea, pallor, and elevated fetal heart rate with marked variability suggest systemic infection requiring immediate evaluation and treatment.

Choice D rationale

Phrenic nerve injury typically causes diaphragmatic paralysis, leading to asymmetric chest movement and respiratory distress. However, it does not explain the systemic signs like pallor or elevated heart rate, making it an unlikely cause.