Persistent pulmonary hypertension of the newborn — MRCPCH FOP MCQ

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HardNeonatologyPersistent pulmonary hypertension of the newbornMRCPCH FOP

A term baby with meconium exposure has labile cyanosis. Pre-ductal oxygen saturation is 94% and post-ductal saturation is 82%; echocardiography excludes structural heart disease. What is the most likely diagnosis?

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Correct answer: D — Persistent pulmonary hypertension of the newborn

Marked pre- and post-ductal saturation difference with no structural lesion suggests right-to-left ductal shunting from persistent pulmonary hypertension. Transient tachypnoea may cause oxygen requirement but not usually a large ductal saturation gradient. Choanal atresia causes cyclical cyanosis relieved by crying. The pearl is that comparing right hand and foot saturations can identify ductal shunting physiology.

Reference: NICE neonatal respiratory care; BAPM PPHN guidance