Cyanotic newborn case/ Landvoigt

Question 1

Central cyanosis?

Answer 1

face, upper body, mucus membranes blue

associated with desaturation of arterial blood

Question 2

Peripheral cyanosis?

Answer 2

Oral mucous membranes pink
distal extremities blue
associated with cool ambient temperature

Question 3

Patient history?

Answer 3

uncomplicated prenatal, poor prenatal care, denies alcohol substance abuse
smoke for first 6 wks

not crying a lot, vaginally delivered, tachycardiac
slightly cyanotic otherwise healthy, recieved APGARs of 7 and 8

family- brother and dad had whole in heart

Question 4

Cyanotic newborn categories?

Answer 4

CNS
Respiratory
Cardiovascular
Inflammatory
Other

Question 5

Under respiratory?

Answer 5

Drive
Airway
Parenchyma
Pleural space

Question 6

Under CV?

Answer 6

Pulmonary HTN

CHD

Question 7

Inflammatory?

Answer 7

Sepsis

Question 8

CNS?

Answer 8

any disorder causing hypoventilation (transmission of maternal sedation, serizure, neurmuscular disorder, or intraventricula hemorrhage)

Question 9

Congential heart disease typically?

Answer 9

R to L shunt

Question 10

Lung disease?

Answer 10

any disorder causing severe V/Q mismatch or airway obstruction
(respiratory distress syndrome, congenital diaphragmatic hernia (CDH), pneumothorax, or airway stenosis)

Question 11

Other?

Answer 11

Methemoglobinemia

anemia

Question 12

Physical exam?

Answer 12

significant for cyanosis especially on shoulders, face, and lips
tachypneic but lung ascultation is undremarkable bilaterally
prominant precordial heave, single loud s2, no mumur, and equal pulses
remainder of the physical exam is unremarkable

Question 13

performed a ABG and? (Hyperoxia test)

Answer 13

ABG on room air has a PaO2= 35 mmHg
repeat ABG has a PaO2= 39 mmHg
it seems that the patient has a cyanotic congenital heart defect (R-L shunt)

Question 14

Echocardiogram of patient?

Answer 14

d-transposition of the great vessels with intact ventriclar septum

Question 15

Transposition of vessels on CXR?

Answer 15

egg on a string

Question 16

Ductal dependent lesions?

Answer 16

cardiac lesion requiring a patent ductus arteriosus (PDA) to maintain life
infant may seem normally initially after birth
present with profound hypoperfusion or cyanosis during the late neonatal period
dependent of ductus for systemic and pulmonary blood flow or for mixing of systemic and pulmonary circulation

Question 17

Examples of ductal dependent lesions?

Answer 17

pulmonary blood flow

systemic blood flow

Question 18

Pulmonary blood flow?

Answer 18

lesions involve severe obstruction to the right ventricular outflow tract, or anomalous circulation requiring R/L mixing

usually present with evidence of hypoxemia during the neonatal period

Question 19

Systemic blood flow?

Answer 19

lesion involves severe obstuction to the left ventricular outflow tract (HLHS)

usually present with evidence of cardiogenic shock during the neonatal period

Question 20

Alprostadil?

Answer 20

prostaglandin E1
relax smooth muscle causing vasodilation
infused continuously to maintain the DA

Question 21

Adverse effects Alprostadil?

Answer 21

apnea, bradycardia, hypotension, fever, flushing

Question 22

Prolonged treatment of Alprostadil may cause?

Answer 22

ductal fragility or rupture

Question 23

Differ methemoglobemia?

Answer 23

Sat monitor look low