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• W4386728508 abstract "Figure: Algorithm for Evaluating and Managing Suspected Congenital Heart Disease in NeonatesFigureAn 8-day-old male infant, ex-full-term, born by normal spontaneous vaginal delivery and discharged home two days after birth without identified complications or maternal infections, was brought by his parents to the emergency department due to decreased activity. Starting at age 6 days, the family noted that feeding appeared to be taking longer and the mother thought her infant was breathing faster. The baby was pale, dusky, and lethargic, and had mottled skin. His rectal temperature was 36.3°C, heart rate was 170 bpm, respiratory rate was 60 bpm, blood pressure was 62/35 mm Hg, and SpO2 was 70% on room air. A physical examination demonstrated a flat fontanelle, regular rate and rhythm without additional heart sounds or murmurs, coarse breath sounds, and hepatomegaly with liver edge 3 cm below the costal margin. His capillary refill was delayed at five to six seconds. Supplemental oxygen was applied without effect. Neonates with undiagnosed congenital heart disease may present to the emergency department with nonspecific symptoms, and may be considerably unstable and require immediate life-saving interventions. (ddxof; Sept 25, 2017; http://bit.ly/2qlUqiv.) The key historical features are respiratory difficulty, feeding difficulty (small quantities, diaphoresis during feeding), poor weight gain, chromosomal abnormalities and syndromes, maternal risk factors such as diabetes, teratogen exposure, substance use, and an affected sibling. Key findings are tachycardia, tachypnea, hypotension, blood pressure differential (RUE vs. LE >8 mm Hg difference), pulse oximetry differential (RUE vs. LE >4% difference, <95%), and a murmur, thrill, pulse differential, capillary refill, and hepatomegaly. The workup should include a chest x-ray to evaluate for cardiomegaly and pulmonary vascular congestion, an ECG to evaluate for axis deviation (right axis deviation is normal for neonates), and an arterial blood gas with co-oximetry. Special thanks to Kelly Young, MD, the director of the pediatric emergency medicine fellowship at Harbor-UCLA Medical Center Department of Emergency Medicine. Suggested Reading: Weiner, G. (Ed.) (2016.) Textbook of Neonatal Resuscitation. (7th edition.) Elk Grove Village, IL: American Academy of Pediatrics and American Heart Association. Lissauer T, et al. (2015.) Neonatology at a Glance. (2nd edition.) Oxford, UK: Wiley & Sons. Steinhorn RH. Evaluation and Management of the Cyanotic Neonate. Clin Pediatr Emerg Med. 2008;9(3):169. Gomella T, et al. (2013.) Neonatology. (7th edition.) New York, NY: McGraw-Hill Professional. Yee L. Cardiac emergencies in the first year of life. Emerg Med Clin North Am. 2007;25(4):981. Yates MC, Rao PS. Pediatric cardiac emergencies. Emerg Med. 2013;3(6):100016. Silberbach M, Hannon D. Presentation of congenital heart disease in the neonate and young infant. Pediatr Rev. 2007;28(4):123. Brousseau T, Sharieff GQ. Newborn emergencies: The first 30 days of life. Pediatr Clin North Am. 2006;53(1):69." @default.
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• W4386728508 date "2019-11-26" @default.
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• W4386728508 title "ddxof" @default.
• W4386728508 doi "https://doi.org/10.1097/01.eem.0000615356.36330.1c" @default.
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