Neonatal cyanosis

Question 1

History

Answer 1

1. Pregnancy
GDM
Oligohydramnios
Pregnancy HTN
Maternal age
2. Labour
PPROM
GBS +ve
Maternal fever
Preterm
LUSCS

Question 2

Physical examination

Answer 2

1. Vital signs
Respiratory distress
Sepsis
2. Four limb BP
3. Murmurs

Question 3

Investigations

Answer 3

1. ABG
2. FBE
3. BGL
4. UEC
5. BC, septic screen
6. Consider fluid boluses if hypoT and acidosis
7. ECHO
8. 02 sats->right and left
9. CXR
10. ECG

Question 4

Hyperoxia test

Answer 4

1. 100% Fi02 in headbox for 10minutes
2. Monitor oxygen saturation, repeat ABG
3. 02 / stats + by 15%->pulmonary disease likely
4. P02 cardiac or PPHN likely

Question 5

Management

Answer 5

1. Resuscitation
2. Intubation if ++distress
3. Two IV lines
4. Fluid boluses if needed
5. Investigations
6. IV antibiotics post cultures
7. Prostaglandin E1 infusion if duct dependent cardiac disease suspected
8. Consider ionotrope support to maintain BP
9. Refer to pediatric cardiac centre if required

Question 6

Etiology

Answer 6

1. Primary pulmonary
   TachyP, no right-left difference, +CO2, no metabolic acidosis, responds to +02
2. Cardiac
   TachyP, deep slow breathing, right-left 02 difference (5-10%), normal or -ve CO2, severe metabolic acidosis, no sigN change to +02
3. PPHN
   TachyP, grunting, recession, >10-15% difference right-left, normal/+CO2, +/- metabolic acidosis, +/- response to 02, evidence of right ventricular strain ECG
4. Sepsis
   Resp distress (not if not primary lung pathology), no difference right-left, CO2 normal/+increased, +/- metabolic acidosis, moderate response to 02 (blunted due to low output)

Question 7

Evidence of ductal dependent pulmonary circulation

Answer 7

1. Cyanosis
2. TachyP w/o respiratory distress
3. Adequate peripheral perfusion
   4 TGA, pulmonary stenosis