Review baby with poor feeding

You go to review the poorly feeding baby on postnatal ward who is now 15 hours old. On the way, you are bleeped by the ED nurses who will check the jaundiced baby’s bilirubin level and will contact you once the result is back.

Bella Potter was born at 41 weeks gestation with a birthweight of 3.0kg. Mum booked late in her pregnancy. Her initial scan at 17 weeks was reported normal, as was a subsequent scan at 22 weeks. This was mother’s first pregnancy. She used to smoke, but denied smoking during pregnancy. She is otherwise well and had no complications during her pregnancy.

Bella was born vaginally following spontaneous onset of labour. Mother’s waters broke 18 hours before delivery. There was a history of meconium stained liquor at delivery, which was suctioned by the midwife. Baby cried at 30 seconds and was dried and warmed, with no further resuscitation required. Apgars were scored at 8 at 1 minute, 9 at 5 minutes.  

Examination is undertaken: 

Respiratory: RR 70/min, subcostal recessions. Grunting. Clear breath sounds, air entry audible. Oxygen saturations on right hand are 73%, right foot 72%.

Cardiovascular: HR 160/min. Blue lips and peripheries noted. Left arm cuff BP 70/38, MABP 40, no difference between upper and lower limb BP. There is a grade 3 ejection systolic at the upper left sternal border which radiates across the praecordium. Her heart sounds are normal. Femoral pulses palpable bilaterally.

Abdomen: Not distended, soft on palpation. 1cm liver edge palpable below costal margin.

Neurological: Active and crying, moving all 4 limbs to stimulation. Normotensive anterior fontanelle.

You recognise that this baby has signs of respiratory distress with grunting, tachypnea and hypoxia and bring the baby to the neonatal unit. You contact the registrar to review her urgently.

The baby is started on 100% oxygen. Her oxygen saturations after 10 minutes remain 73%. A cannula is sited and blood tests including full blood count, renal profile, liver function, CRP, and blood culture taken.

She is started on benzylpenicillin and gentamicin and given a 20ml/kg normal saline bolus.

Capillary blood gas:

pH 7.27
pCO₂ 7.9 kpa 
pO₂ 4.5 kPa 
HCO₃ 21.6 mmol/l
BE -2.4 mmol/l
Lactate 2.2 mmol/l
Glucose 4.1 mmol/l

You request a chest x-ray:

Case courtesy of A.Prof Frank Gaillard, Radiopaedia.org.
From the case rID: 8049

The registrar calls the consultant for support.

What treatment option should be considered next?