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Newborn hearing screen — RACP Paediatrics MCQ

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HardNeonatalNewborn hearing screenRACP Paediatrics

A 3-day-old becomes pale and mottled with weak femoral pulses, metabolic acidosis and a 25 mmHg upper-to-lower-limb systolic blood-pressure difference. Oxygen has little effect. Sepsis treatment is starting while echocardiography and retrieval are arranged. What additional treatment should be considered immediately?

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Reveal the answer and explanation

Correct answer: A — Start intravenous prostaglandin E1 while organising definitive cardiac assessment

Explanation lettering: D = shown as A · A = shown as B · E = shown as D · B = shown as E

D is correct because shock emerging with ductal closure, weak femoral pulses and an arm–leg pressure gradient suggests duct-dependent systemic blood flow; prostaglandin E1 should be considered after urgent specialist discussion while diagnosis and transfer proceed. A would further close the lifeline duct. B cannot restore systemic outflow. C may help selected pulmonary hypertension but does not bypass left-sided obstruction. E worsens shock and is not neonatal stabilisation. Sepsis remains an important parallel diagnosis, so cultures and empirical antibiotics should not be abandoned.

Reference: Royal Children’s Hospital Melbourne, recognition of the seriously unwell neonate and young infant: https://www.rch.org.au/clinicalguide/guideline_index/Recognition_of_the_seriously_unwell_neonate_and_young_infant/