Paeds Vivas · fetal-neonatal-and-perinatal
Antenatally diagnosed fetal conditions: paediatric planning — branching viva
Branching viva from a confirmed hypoplastic left heart syndrome through ductal-dependence reasoning, a diaphragmatic hernia resuscitation error, an EXIT airway scenario, and the paediatrician's antenatal planning role.
On this page
Study tools
Target exams
RACP General PaediatricsRACP DCEMRCPCH ClinicalRCPSC Pediatrics
Prompt
You are the paediatric registrar at the antenatal multidisciplinary meeting. A fetus has a confirmed hypoplastic left heart syndrome. The examiner releases information in stages about ductal-dependence reasoning, a diaphragmatic hernia resuscitation error, an EXIT airway scenario, and the paediatrician's planning role.
Station opening
Examiner: "The fetal echocardiogram confirms hypoplastic left heart syndrome with a normal karyotype. What is your planning role?" [1]
Strong candidate (must-hit)
- Confirms the diagnosis and judges it time-critical and ductal-dependent; the paediatrician's role is to translate the diagnosis into a postnatal plan — place, time and capability of delivery. [1] [2]
- Plans a cardiac-centre delivery with prostaglandin E1 ready from birth, and the staged surgical strategy with neurodevelopmental follow-up. [1] [19]
Weak candidate
- "That is cardiology; I will see the baby on the ward after surgery." [1]
- Memorises a prostaglandin dose but cannot say why timing matters or who briefs the team. [19]
References7ShowHide
- [1]Donofrio MT, Moon-Grady AJ, Hornberger LK, et al. Diagnosis and treatment of fetal cardiac disease: a scientific statement from the American Heart Association. Circulation, 2014.PMID 24763516
- [2]Benachi A, Sarnacki S. Prenatal counselling and the role of the paediatric surgeon. Seminars in pediatric surgery, 2014.PMID 25459006
- [7]Snoek KG, Reiss IK, Greenough A, et al. Standardized Postnatal Management of Infants with Congenital Diaphragmatic Hernia. Neonatology, 2016.PMID 27077664
- [9]Bhat V, Moront M, Bhandari V. Gastroschisis: A State-of-the-Art Review. Children (Basel), 2020.PMID 33348575
- [18]Conner P, Vejde JH, Burgos CM, et al. Accuracy and impact of prenatal diagnosis in infants with omphalocele. Pediatric surgery international, 2018.PMID 29637257
- [19]Tulzer A, Huhta JC, Hochpoechler J, et al. Hypoplastic Left Heart Syndrome: Is There a Role for Fetal Therapy? Frontiers in pediatrics, 2022.PMID 35874565
- [20]Martinez-Biarge M, Jowett VC, Cowan FM, et al. Neurodevelopmental outcome in children with congenital heart disease. Seminars in fetal & neonatal medicine, 2013.PMID 23706956