A mother delivers a neonate with meconium staining and Apgar scores of 3 at 1 and 5 minutes of life. She had no prenatal care and the delivery was by emergency cesarean section for what the obstetricians report as "severe fetal bradycardia." Which of the following sequelae could be expected to develop in this intubated neonate with respiratory distress?

The low Apgar scores, meconium staining, and ensuing respiratory distress suggest that asphyxia has occurred. During a period of asphyxia, the resulting hypoxemia, acidosis, and poor perfusion can damage a neonate's brain, heart, kidney, liver, and lungs. The resulting clinical abnormalities include cerebral edema, irritability, seizures, cardiomegaly, heart failure, renal failure, poor liver function, disseminated intravascular coagulopathy, and respiratory distress syndrome. There can be excessively high pulmonary arterial pressure at the same time systemic blood pressure begins to fall, resulting in a persistent right-to-left shunt across a patent ductus arteriosus or foramen ovale. This condition is known as persistent pulmonary hypertension of the newborn (PPHN).