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Coarctation of the aorta — RACP Paediatrics MCQ

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HardCardiologyCoarctation of the aortaRACP Paediatrics

A 5-day-old infant presents with poor feeding, mottling and metabolic acidosis. Upper limb pulses are strong but femoral pulses are weak; oxygen saturations are similar in the right hand and foot. What is the most appropriate management?

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Correct answer: A — Start prostaglandin E1 and arrange urgent echocardiography

Shock with weak femoral pulses after ductal constriction suggests critical coarctation of the aorta, so prostaglandin E1 should be started to reopen/maintain ductal flow and echocardiography arranged. Equal saturations do not exclude coarctation. The pearl is that neonatal shock can be cardiac even without cyanosis.

Reference: RCH Clinical Practice Guidelines: Recognition of the seriously unwell neonate; Therapeutic Guidelines (eTG)