Persistent pulmonary hypertension of the newborn

Branch 1: Recognition and Initial Assessment

A 39-week infant born via planned Caesarean section develops grunting, tachypnoea, and central cyanosis at 3 hours of age. Pre-ductal SpO₂ reads 85% and post-ductal reads 68% on 60% FiO₂. The 17% pre–post ductal SpO₂ gradient in a term infant with respiratory distress and cyanosis is the key finding — it confirms right-to-left ductal shunting and points toward persistent pulmonary hypertension of the newborn. The planned Caesarean delivery without labour is a recognised risk factor for PPHN. ^[1]

I would assess ABC immediately: ensure the airway is patent, evaluate the work of breathing, and measure heart rate, blood pressure, perfusion, and capillary refill. I would place pre- and post-ductal pulse oximetry probes on all four limbs to map the shunt, and establish intravenous access for blood gas, glucose, calcium, and cultures. ^[1]