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Duct-dependent congenital heart disease — RACP Paediatrics MCQ

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HardNeonatologyDuct-dependent congenital heart diseaseRACP Paediatrics

A 12-hour-old term neonate has central cyanosis and oxygen saturation 76% in air and 78% after 10 minutes of high-flow oxygen. Femoral pulses are weak, the liver is enlarged and a soft systolic murmur is present. Chest X-ray shows a narrow mediastinum. What is the most appropriate management?

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Correct answer: B — Start prostaglandin E1 infusion and obtain urgent cardiology review

Fixed cyanosis that does not correct with oxygen and poor femoral pulses strongly suggests duct-dependent congenital heart disease. Prostaglandin E1 can reopen or maintain ductal patency while urgent echocardiography and retrieval are arranged. A soft murmur does not exclude critical congenital heart disease, particularly early after birth.

Reference: RCH Cyanotic episodes guideline; RACP Knowledge Guides