A newborn baby is being assessed after a complicated delivery. She has a heart rate of 90 and her trunk is pink. The baby is coughing and has some activity. Her respirations are irregular and labored.
22.5 Pathologic Conditions More Commonly Seen in Preterm (Born before 37 Weeks of Gestation) and Low-Birth-Weight Infants (< 3.3 lbs or < 1,500 g)
In preterm infants (<34 weeks gestation age), antenatal corticosteroid therapy has been shown to reduce the incidence of respiratory distress syndrome, intraventricular hemorrhage, necrotizing enterocolitis, sepsis, and neonatal mortality by approximately 50 percent.
Risk factors: The most important risk factor is prone sleeping (sleeping on stomach). Other risk factors include siblings of infants who died from SIDS, prematurity, low birth weight, and exposure to cigarette smoke.
3. A mother brings in her 13-month child for a routine check-up. The baby can say simple words like “mama” and “ta-ta.” She can walk alone a few steps and is able to throw a ball. What is the likely developmental assessment in this child?
First dose (given between 1 and 2 years of age) e
Additional vaccination: Influenza is given yearly after 6 months of age. Children 6 months to 8 years of age who are receiving flu vaccination for the first time in their life, require 2 doses of vaccine in that single season to optimize response.
, severe combined immunodeficiency)
The only murmur that might be physiologic is the grade I or II ejection mid- systolic murmur that decreases with preload reduction (e.g., standing, Valsalva). – NSIM in a well-looking child is reassurance, after ruling out anemia.
Development of right-to-left shunt can occur later in life, due to development of the following pathology: increased pulmonary artery blood flow pulmonary hypertension (loud pulmonic S2) increased right heart pressure RV (right ventricle) hypertrophy. Pressure generated by hypertrophied right heart + increased pulmonary pressure leads to right-sided pressure becoming greater than on the left side, resulting in right-to-left shunt and development of cyanosis. This is called Eisenmenger syndrome and it usually develops later.3
When Eisenmenger syndrome develops in PDA, postductal circulation starts receiving mixed blood, which results in differential cyanosis (lower body is cyanotic, toes develop clubbing, whereas upper body remains unaffected).
Differential cyanosis can also occur with preductal coarctation and coexistent PDA. In this case the differential cyanosis is early-onset as it does not require development of Eisenmenger syndrome (area distal to coarctation may have lower pressures than pulmonary circulation leading to right-to-left shunt).
Pulmonary vascular markingsa
bTOF and TVA may have some common features. To differentiate TOF from TVA, look at the axis on EKG: there is right-axis deviation in TOF and left-axis deviation in TVA ( see next page discussion on how to determine axis in EKG).
cTo be compatible with life, most neonatal cyanotic heart diseases (e.g., transposition of great vessels, TAPV, TVA, hypoplastic left heart) require PDA or ASD (in some cases VSD) to supply systemic circulation. These conditions may become acutely symptomatic after 2-3 days, when ductus arteriosus normally closes.
Prostaglandin infusion (PGE1) can be used to keep the PDA patent until definitive surgical correction.
Pathophysiology: Narrowing of the aorta, due to thickening of tunica media near the ductus arteriosus. It is often associated with other heart defects such as ASD, VSD, PDA, and/or bicuspid aortic valve.
When only lead I is up, your left hand is up, and axis is tilted to left side = left-axis deviation. Note: when you write 1, 2, 3, 4, …, 1 is always written in the left side, and 3 is always written in the right.
7. A 6-month-old male baby is brought in for a routine check-up. As soon as you put the stethoscope on the baby’s chest he starts crying, breathes rapidly, and begins to turn a dusky blue color. In addition to oxygen, which of the following will rapidly alleviate these symptoms?
8. You are examining a newborn male baby just after delivery. His entire trunk is blue. He has a pulse rate of 90, grimaces with some activity. His respirations are irregular with an oxygen saturation of 80%. He ends up requiring intubation. On auscultation you hear a single loud S2 and a harsh murmur in the left lower sternal border. What is the baby’s APGAR score and the likely diagnosis?
cAll other conditions listed in the table can be differentiated from Hirschsprung disease by looking at colonic air. Hirschsprung has increased colonic air. If colonic air is absent, it is not Hirschsprung.