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Case 1 Presentation
A 40-week, 4.6-kg male infant was born by elective Cesarean delivery secondary to macrosomia to a 17-year-old G1P1 mother. Pregnancy was uncomplicated. All prenatal laboratory screenings including glucose tolerance test were within normal limits. APGAR scores were 6 at 1 minute and 9 at 5 minutes. He cried spontaneously and was stable breathing room air. At 12 hours after birth, he was noted to have intermittent desaturations to 88% breathing room air with normal heart rate on routine pulse oximetry in newborn nursery. He was transferred to the NICU for the evaluation of desaturations. On admission, oxygen saturations on pulse oximetry oscillated between 85% and 88% while breathing 100% oxygen with flow of 2 L per minute via nasal cannula. On physical examination, he had no dysmorphic features or respiratory distress. Cardiac examination revealed normal heart sounds without murmur on auscultation. Pulses were equal in all extremities. Laboratory tests including complete blood count, serum chemistry, and CRP were within normal limits. Chest radiograph revealed normal lung parenchyma and cardiac silhouette. Subsequently, the neonate developed an episode of supraventricular tachycardia (SVT) with desaturations to 80%. Twelve-lead ECG showed a narrow QRS complex tachycardia, rate of 250 beats per minute, and abnormal P waves. A dose of intravenous adenosine (500 mcg/kg) converted his heart rate to sinus rhythm immediately. Echocardiogram revealed the diagnosis.
Case 2 Presentation
A 1035 g, 31 5/7-weeks small for gestational age infant was born by Caesarian delivery to a 29-year-old G3P2 woman whose pregnancy was complicated by oligohydramnios and intrauterine growth retardation. The infant displayed mild respiratory distress at birth and required high-flow nasal cannula 1 to 3 L per minute with an FiO2 of 0.21. On the second day after birth, a peripherally inserted central catheter (PICC) was placed on the fourth attempt in the right antecubital fossa. Good …
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