A newborn boy is undergoing examination in the delivery room immediately following birth. He was born via spontaneous vaginal delivery at 39 weeks gestation to a primigravid 15-year-old adolescent. Delivery was complicated by meconium-stained amniotic fluid. The mother received prenatal care and had an uncomplicated pregnancy. At 5 minutes of life, the patient's heart rate is 120/min and respiratory rate is 50/min. He is flexing his extremities, and he moves and cries vigorously in response to stimulation. The patient has cyanosis of the hands, feet, and circumoral area; the remainder of his skin is pink. Which of the following interventions is indicated during this patient's hospital stay?

Question

A newborn boy is undergoing examination in the delivery room immediately following birth.  He was born via spontaneous vaginal delivery at 39 weeks gestation to a primigravid 15-year-old adolescent.  Delivery was complicated by meconium-stained amniotic fluid.  The mother received prenatal care and had an uncomplicated pregnancy.  At 5 minutes of life, the patient's heart rate is 120/min and respiratory rate is 50/min.  He is flexing his extremities, and he moves and cries vigorously in response to stimulation.  The patient has cyanosis of the hands, feet, and circumoral area; the remainder of his skin is pink.  Which of the following interventions is indicated during this patient's hospital stay?

Quizplus · Accepted Answer

11ec25c8_d636_6ae7_bc81_73abb17b8dd1_MD0003_00 This is a healthy newborn with an Apgar score of 9 at 5 minutes of life. Although he has acrocyanosis (blue extremities, pink body), this benign finding is common in the first days of life due to initial peripheral vasoconstriction. Typical management involves routine newborn care, including screening for critical congenital heart disease (CHD) with pre- and post-ductal pulse oximetry. Apgar score Critical CHD includes heart defects that require early (within 1 year) intervention, such as ductal-dependent and cyanotic lesions. One-third of patients with critical CHD are asymptomatic for the first few days of life (due to patent ductus arteriosus) and may remain undetected during hospitalization. Universal screen with pre-ductal (right arm) and post-ductal (either leg) oxygen saturations allows early detection of critical CHD and decreases morbidity and mortality associated with delayed diagnosis. Echocardiogram is indicated for a positive screen (<90% in either extremity, <95% in both upper and lower extremities, or >3% difference between upper and lower extremities). (Choice A) Chest x-ray is indicated for suspicion of meconium aspiration syndrome, which presents with tachypnea (>60/min), increased work of breathing (eg, retractions), and cyanosis. This patient does not show signs of respiratory distress. (Choice B) Echocardiogram evaluates for CHD in a patient with a positive CHD screen or cyanosis, rather than acrocyanosis, on examination. (Choice C) Electrocardiogram is warranted in a patient with bradycardia and suspected neonatal heart block. This patient's heart rate of 120/min is normal for age. (Choice D) Hyperoxia test (administering 100% oxygen) can distinguish between cyanosis due to pulmonary disease (improves with oxygen) and CHD (persistent cyanosis). Because this patient does not have central cyanosis, hyperoxia test is not helpful. Educational objective: Routine newborn care includes screening for critical congenital heart disease (eg, ductal-dependent lesions, cyanotic heart disease) with pre- and post-ductal pulse oximetry in all infants. References: Pulse oximetry and auscultation for congenital heart disease detection. (http://www.ncbi.nlm.nih.gov/pubmed/28939700) Association of US state implementation of newborn screening policies for critical congenital heart disease with early infant cardiac deaths. (http://www.ncbi.nlm.nih.gov/pubmed/29209720)

A Newborn Boy Is Undergoing Examination in the Delivery Room