Pediatrics

Newborn with cyanosis

Shilpa Gulati on May 26, 2013

A newborn boy is born on your service at 37-weeks-gestation to a G1P1 mom via normal spontaneous vaginal delivery. The pregnancy was without concern but mom missed most of the visits scheduled in the second half of her pregnancy. However, the baby’s APGARS at 1 and 5 minutes are 6 and 6; he cries immediately but appears cyanotic at 1 min. The neonatal resuscitation team starts bag-mask positive pressure ventilation, and at 5 min he remains blue with tachypnea and dyspnea despite 100% oxygen via mask. The patient becomes bradycardic and bag-mask ventilation is started, but his HR remains around 45 bpm.

 

On exam you notice that his heart sounds are diminished on the left and he lacks lung sounds on the same side. His abdomen appears scaphoid.

What is the most likely diagnosis?

Expand all answers
Meconium aspiration
Pneumothorax
Congenital diaphragmatic hernia
Choanal atresia

What is your best next step?

Expand all answers
Administer IV atropine
Administer IV epinephrine
Begin chest compressions
Intubate with endotracheal tube
Crying and bag-mask ventilation worsen condition by causing swallowing of air and inflation of intestines in the chest


What additional tasks are important in resuscitation?

Expand all answers
Supportive care
Insertion of an NG tube
Administer IV glucose
Administer IV bicarbonate

Which of the following is true:

Expand all answers
Surgical repair should occur in the delivery room
Patients suffer no long term pulmonary complications following repair
Patients usually have persistent pulmonary and nonpulmonary problems


CDH cannot be diagnosed by prenatal ultrasound
CDH often presents similar to a tension pneumothorax

A newborn boy is born on your service at 37-weeks-gestation to a G1P1 mom via normal spontaneous vaginal delivery. The pregnancy was without concern but mom missed most of the visits scheduled in the second half of her pregnancy. However, the baby’s APGARS at 1 and 5 minutes are 6 and 6; he cries immediately but appears cyanotic at 1 min. The neonatal resuscitation team starts bag-mask positive pressure ventilation, and at 5 min he remains blue with tachypnea and dyspnea despite 100% oxygen via mask. The patient becomes bradycardic and bag-mask ventilation is started, but his HR remains around 45 bpm.

 

On exam you notice that his heart sounds are diminished on the left and he lacks lung sounds on the same side. His abdomen appears scaphoid.

What is the most likely diagnosis?

Expand all answers
Meconium aspiration
Pneumothorax
Congenital diaphragmatic hernia
Choanal atresia

What is your best next step?

Expand all answers
Administer IV atropine
Administer IV epinephrine
Begin chest compressions
Intubate with endotracheal tube
Crying and bag-mask ventilation worsen condition by causing swallowing of air and inflation of intestines in the chest


What additional tasks are important in resuscitation?

Expand all answers
Supportive care
Insertion of an NG tube
Administer IV glucose
Administer IV bicarbonate

Which of the following is true:

Expand all answers
Surgical repair should occur in the delivery room
Patients suffer no long term pulmonary complications following repair
Patients usually have persistent pulmonary and nonpulmonary problems


CDH cannot be diagnosed by prenatal ultrasound
CDH often presents similar to a tension pneumothorax

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