At a neighbor’s party about 2 weeks ago, I began talking to a woman who showed me a photo of her handsome 27-year-old son and thanked me for helping him when he was a newborn.
I have lived in the same Evanston, IL, neighborhood for 32 years, and I frequently enjoy hearing follow-up about infants I cared for a long time ago.
In this specific case, the woman’s child at age 9 days had presented in shock to the Emergency Department (ED) of a community hospital. He was born at term and discharged at age 2 days. In retrospect, he had had a “piddling” systolic murmur at the time of discharge but was clinically well.
As the covering pediatrician, I rushed to the ED and heard the story. I did not appreciate a murmur, and the boy was poorly perfused. At this time in medicine, pulse oximetry was not yet available, and Prostaglandin E1 (PGE1) had only recently become accessible to redilate the ductus arteriosus in babies with ductal-dependent congenital heart disease.
I then remembered that a year or so before, I had visited another small community hospital to evaluate a term newborn girl who sounded at first like she might have sepsis; however, when I arrived with the transport team, the clinical scenario sounded more like a ductal-dependent lesion. At that particular time, PGE1 was only available at children’s hospitals and was not available on transport or in community hospitals. We followed the ABCs (Airway, Breathing, Circulation) on this tiny girl and made a stressful run for it to the children’s hospital, where PGE1 was available. Fortunately, she survived through the transport and was able to receive PGE1 before surgery.
A year later, on that night in the Evanston ED, PGE1 was available. After following the ABCs, I placed an umbilical venous catheter, started PGEI, and the little boy was nicely stabilized during transport to the children’s hospital.
That was 27 years ago. At the recent party, his mother disclosed that he is now getting married and having a family.
These anecdotes were called to mind as I read two recent NeoReviews articles about newborns with cyanosis and the efforts to screen them for congenital heart disease (1)(2).
Also, the Video Corner by Hua and co-authors about a cyanotic newborn with a reverse saturation clinical picture with D-transposition of the great arteries (3) is a clinically relevant example of being sensitive to the possibility of cyanotic congenital heart disease and also, specifically, to my recollections of ductal-dependent congenital heart disease.
By the way, in case you were wondering, the little girl had an interrupted aortic arch, and the boy had a severe coarctation of the aorta.
- Dasgupta S, Bhargava V, Huff M, et al. Evaluation of the cyanotic newborn: Part I—A neonatologist’s perspective. NeoReviews. 2016;17(10):e598-e604, DOI: 10.1542/neo.17-10-e598. Accessed at: http://neoreviews.aappublications.org/content/17/10/e598 on 9/13/2017
- Dasgupta S, Bhargava V, Huff M, et al. Evaluation of the cyanotic newborn: Part 2—A cardiologist’s perspective. NeoReviews. 2016;17(10):e605-e620. DOI: 10.1542/neo.17-10-e605. Accessed at: http://neoreviews.aappublications.org/content/17/10/e605 on 9/13/17.
- Hua N, Yieh L, Dukhovny D, Armsby L. Video Corner: Important Considerations in the Management of Newborns with Cyanosis. NeoReviews. 2017;18(4):e258-e264, DOI: 10.1542/neo.18-4-e258. Accessed at: http://neoreviews.aappublications.org/content/18/4/e258 on 9/13/17 on 9/13/17