A Insert an umbilical artery catheter to ensure his Paco₂ is less than 65 mmHg (8.7 kPa).

[Feedback :- At this point he does not require monitoring of arterial blood gases, so an umbilical artery catheter is not required, but this would need to be reassessed if the oxygen requirement significantly increases or his condition deteriorates. Some units would collect a capillary or venous gas to ensure that pH and Pco₂ are within acceptable limits.]

B Commence 10% dextrose at 60 ml kg^–1 per day.

[Feedback :- This should be done, but the most important task is the commencement of antibiotics.]

C Get a chest radiograph to exclude infection or pneumothorax.

[Feedback :- This should be done, but the most important task is the commencement of antibiotics.]

D Take blood cultures and commence IV antibiotics.

This is the Correct Answer

[Feedback :- This baby is at significant risk of congenital sepsis and therefore antibiotics should be commenced. Options B and C should be done as well, but the most important task is the commencement of antibiotics.]

E Commence nasal CPAP.

[Feedback :- Many units would commence CPAP on this baby, but it would also be reasonable to leave him in cot oxygen.]