A 6-day-old boy in the neonatal intensive care unit has a heart murmur. The patient was born at 27 weeks gestation and intubated due to surfactant deficiency. Birth weight was 1.14 kg (2 lb 8 oz). Temperature is 37 C (98.6 F), blood pressure is 66/12 mm Hg, and pulse is 182/min. A continuous murmur with systolic accentuation is best heard at the left heart border. There are bounding femoral and palmar pulses. Abdominal examination is unremarkable. Blood culture is sterile. Elevated levels of which of the following substances is most likely contributing to this patient's condition?

Question

A 6-day-old boy in the neonatal intensive care unit has a heart murmur.  The patient was born at 27 weeks gestation and intubated due to surfactant deficiency.  Birth weight was 1.14 kg (2 lb 8 oz).  Temperature is 37 C (98.6 F), blood pressure is 66/12 mm Hg, and pulse is 182/min.  A continuous murmur with systolic accentuation is best heard at the left heart border.  There are bounding femoral and palmar pulses.  Abdominal examination is unremarkable.  Blood culture is sterile. Elevated levels of which of the following substances is most likely contributing to this patient's condition?

Quizplus · Accepted Answer

Eductional Objective: Because of placental production of prostaglandin E2 (PGE2) and low oxygen levels in the fetal circulation, the ductus arteriosus remains open in utero. Persistence after birth (ie, patent ductus arteriosus) is associated with elevated postnatal PGE2 and typically manifests in a preterm infant with a continuous murmur, widened pulse pressure, and bounding pulses.

A 6-Day-Old Boy in the Neonatal Intensive Care Unit Has