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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 baby is centrally cyanosed with saturations of 70% in air and 75% after oxygen. Femoral pulses are normal and the chest is clear; arterial blood gas shows mild metabolic acidosis. What is the most appropriate management?

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Correct answer: B — Start prostaglandin E1 infusion and arrange urgent echocardiography

Profound cyanosis with minimal response to oxygen suggests cyanotic congenital heart disease such as transposition, and ductal patency should be maintained with prostaglandin E1. Respiratory treatments are not appropriate when the chest is clear and oxygen response is poor. The pearl is that oxygen-resistant neonatal cyanosis is a cardiac emergency until proven otherwise.

Reference: RCH Clinical Practice Guidelines: Cyanotic episodes; Therapeutic Guidelines (eTG)