A 4-hour-old male newborn has perioral discoloration for the past several minutes. Oxygen by nasal cannula does not improve the cyanosis. He was delivered by cesarean delivery at 37 weeks' gestation to a 38-year-old woman, gravida 3, para 2. Apgar scores were 8 and 9 at 1 and 5 minutes, respectively. Pulse oximetry shows an oxygen saturation of 85%. Cardiopulmonary examination shows a 2/6 holosystolic murmur along the lower left sternal border. The abdomen is soft and non-tender. Echocardiography shows pulmonary arteries arising from the posterior left ventricle, and the aorta rising anteriorly from the right ventricle. Definitive surgical correction of the main congenital abnormality is planned. Pending definitive repair, which of the following temporary measures would be most likely to improve this patient's condition?

Question

A 4-hour-old male newborn has perioral discoloration for the past several minutes. Oxygen by nasal cannula does not improve the cyanosis. He was delivered by cesarean delivery at 37 weeks' gestation to a 38-year-old woman, gravida 3, para 2. Apgar scores were 8 and 9 at 1 and 5 minutes, respectively. Pulse oximetry shows an oxygen saturation of 85%. Cardiopulmonary examination shows a 2/6 holosystolic murmur along the lower left sternal border. The abdomen is soft and non-tender. Echocardiography shows pulmonary arteries arising from the posterior left ventricle, and the aorta rising anteriorly from the right ventricle. Definitive surgical correction of the main congenital abnormality is planned.  Pending definitive repair, which of the following temporary measures would be most likely to improve this patient's condition?

Quizplus · Accepted Answer

Eductional Objective: Transposition of the great arteries is characterized by parallel circulations of deoxygenated and oxygenated blood.  Initial management includes maintaining a left-to-right mixing lesion (eg, patent ductus arteriosus, patent foramen ovale) to provide systemic circulation with partially oxygenated blood.

A 4-Hour-Old Male Newborn Has Perioral Discoloration for the Past