During a CPAP trial, which action should the neonatal/pediatric specialist take if a 28-week-gestation neonate shows significant distress?

When a 28-week-gestation neonate experiences significant distress during a CPAP trial, the most appropriate action is to resume ventilation at the previous settings. This choice prioritizes the immediate well-being and stability of the infant. CPAP, while beneficial for providing respiratory support and preventing atelectasis, may not be suitable for all neonates, especially those with significant distress, which could indicate inadequate ventilation or oxygenation.

Resuming mechanical ventilation can help ensure that the neonate receives the necessary support for adequate gas exchange and respiratory function until they can tolerate CPAP effectively. This action is particularly vital for preterm infants whose respiratory systems are immature and who may quickly deteriorate without sufficient respiratory assistance.

Continuing the CPAP trial and waiting one hour to obtain a blood gas may risk further distress or complications for the neonate, as the condition could worsen in that time frame. A chest x-ray could be helpful for diagnostic purposes but would not be an immediate solution to the acute distress the infant is experiencing. Inserting a chest tube would be indicated only if there was evidence of a pneumothorax or other pleural pathology, which may not be the initial concern in the context of a CPAP trial.