Paeds Vivas · cardiology
Cyanotic newborn and critical congenital heart disease screening — branching viva
Branching viva on the cyanotic newborn: interpreting the pulse-oximetry screen, starting prostaglandin E1 before the echocardiogram, separating cyanotic congenital heart disease from pulmonary and sepsis mimics, and escalating to a cardiac centre.
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RACP DCEMRCPCH ClinicalRCPSC Pediatrics
Prompt
Postnatal ward: a thirty-hour-old term infant, comfortable but dusky on feeding, with a pulse oximetry of 86% in the right hand and 84% in the foot in air and no murmur. The examiner asks you to interpret the screen, justify your concern despite the well appearance, give your immediate management including the drug and the dose, then branches to the oxygen question, the differential and the hyperoxia test, and finally to the two-day-old infant who collapsed at home — a failure of the screening programme.
Opening question
A thirty-hour-old term infant is dusky on feeding but comfortable, with SpO₂ of 86 per cent in the right hand and 84 per cent in the foot in air and no murmur. Interpret the screen against the thresholds, and tell me your immediate next step and your immediate management. [2] [9]
References4ShowHide
- [1]de-Wahl Granelli A, Wennergren M, Sandberg K, et al. Impact of pulse oximetry screening on the detection of duct dependent congenital heart disease: a Swedish prospective screening study in 39,821 newborns. BMJ, 2009.PMID 19131383
- [2]Mahle WT, Newburger JW, Matherne GP, et al. Role of pulse oximetry in examining newborns for congenital heart disease: a scientific statement from the American Heart Association and American Academy of Pediatrics. Circulation, 2009.PMID 19581492
- [9]Vari D, Xiao W, Behere S, et al. Low-dose prostaglandin E1 is safe and effective for critical congenital heart disease: is it time to revisit the dosing guidelines? Cardiol Young, 2021.PMID 33140712
- [8]Aykanat A, Yavuz T, Özalkaya E, et al. Long-Term Prostaglandin E1 Infusion for Newborns with Critical Congenital Heart Disease. Pediatr Cardiol, 2016.PMID 26260095