Paeds Cases · fetal-neonatal-and-perinatal
Neonatal cyanosis and collapsed neonate — structured clinical encounter
Structured encounter testing the approach to a day-3 term infant with sudden central cyanosis: recognition, the pre-/post-ductal and hyperoxia assessment, the time-critical use of prostaglandin E1 before echo, and the parallel sepsis cover.
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Station brief (candidate)
You are the paediatric registrar in the emergency department. A 3-day-old term infant, previously feeding well and discharged home, is brought in dusky and limp. The tongue and lips are blue. The respiratory rate is 60 with mild recession; there is no murmur. The right-arm oxygen saturation is 82%. The antenatal scans and the newborn pulse-oximetry screen were reportedly normal. You have 12 minutes with the team and 5 minutes for examiner discussion. [3]
References5ShowHide
- [1]Wyckoff MH; Wyllie J; Aziz K; de Almeida MF; et al Neonatal Life Support: 2020 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations. Circulation, 2020.PMID 33084392
- [3]Strobel AM; Lu le N The Critically Ill Infant with Congenital Heart Disease. Emerg Med Clin North Am, 2015.PMID 26226862
- [6]Browning Carmo KA; Barr P; West M; Nicholl M; et al Transporting newborn infants with suspected duct dependent congenital heart disease on low-dose prostaglandin E1 without routine mechanical ventilation. Arch Dis Child Fetal Neonatal Ed, 2007.PMID 16905574
- [8]Davis AL; Carcillo JA; Aneja RK; Deymann AJ; et al American College of Critical Care Medicine Clinical Practice Parameters for Hemodynamic Support of Pediatric and Neonatal Septic Shock. Crit Care Med, 2017.PMID 28509730
- [9]Kuzniewicz MW; Puopolo KM; Fischer A; Walsh EM; et al A Quantitative, Risk-Based Approach to the Management of Neonatal Early-Onset Sepsis. JAMA Pediatr, 2017.PMID 28241253