A 3-day-old infant is experiencing respiratory distress with substernal retractions and nasal flaring while receiving 40% oxygen via oxyhood.
Arterial blood gas results are pH 7.28; PaO2 41 mmHg; PaCO2 42 mmHg; HCO3 19 mEq/L.
The infant's most recent chest x-ray is shown above.
Which of the following therapeutic interventions would be most appropriate at this time?
a. intubate and initiate mechanical ventilation
b. increase the oxygen to 50% and continue to monitor
c. apply 5 cmH2O CPAP by nasal prongs with an FIO2 of 0.50
d. increase the oxygen to 100% and continue to monitor