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NeoReviews Vol.10 No.9 2009 e460
© 2009 American Academy of Pediatrics

Index of Suspicion in the Nursery

The first 20% of the full text of this article appears below.


   Case Presentation
 
A 1-day-old male infant develops lower extremity cyanosis after feeding. The infant was born at 38 weeks’ gestation and had Apgar scores of 8 and 9 at 1 and 5 minutes, respectively. There were no prenatal complications. Today he has lower extremity saturations of 80% and upper extremity saturations of 97%. Results of limited/preliminary echocardiography are reported as "pulmonary hypertension and possible aortic arch obstruction." After starting an infusion of prostaglandin E1, the infant is transferred to a tertiary care center for cardiac evaluation.

The initial physical examination reveals a warm, pink neonate who is experiencing no significant distress. His length is at the 75th percentile and weight is at the 25th percentile for age. His temperature is 37.0°C, heart rate is 120 beats/min, respiratory rate is 28 breaths/min, and cuff blood pressure in the right upper extremity is 75/45 mm Hg. No blood pressure gradient is evident between the upper and lower extremities. Oxygen saturation in room air is 98% in the left upper extremity and 85% in the left lower extremity. Lungs are clear and no retractions are noted. Cardiovascular examination reveals a fixed, widely split second heart sound (S2) without an appreciable murmur. Pulses are +2 and equal . . . [Full Text of this Article]

Alejandro Arevalo, MD
Glenn T. Wetzel, MD, PhD
Antonio G. Cabrera, MD

Heart Institute at Le Bonheur Children's Hospital/University of Tennessee, Memphis, Tenn


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