Cardiovascular medicines in children — branching viva

Opening — the cyanotic neonate

Examiner: A two-day-old neonate is cyanotic, tachypnoeic and acidotic, with a suspected duct-dependent lesion. Walk me through your immediate pharmacological management. ^[10]

Candidate (model): I would not wait for echocardiography. I would start an intravenous prostaglandin E1 (alprostadil) infusion immediately at 0.01 to 0.05 microgram per kilogram per minute and titrate upward toward a maximum around 0.1 microgram per kilogram per minute, watching for a rising saturation toward a target of 75 to 85 per cent, a warming perfusion, and a falling lactate. I would secure the airway and have an intubation plan ready, because apnoea is a common adverse effect. I would recognise fever and hypotension as further drug effects, not sepsis, though I would still take cultures and consider antibiotics. Prostaglandin E1 is a bridge to definitive anatomy repair, so I would organise retrieval to a cardiac centre at once. ^[10]