TYK386
A full-term neonate develops cyanosis in the newborn nursery and is transferred to the NICU. The infant is not in respiratory distress, and the chest xray is normal. 100% FiO2 via oxygen hood fails to correct the hypoxemia. PPHN is suspected and an echocardiogram is ordered. Choose the BEST statement:
a) Based on the presentation, diaphragmatic hernia is the likely cause of PPHN in this infant
b) Echocardiogram likely shows bowing of the ventricular septum into the right ventricle, consistent with elevated PVR
c) Hypoxemia despite 20 ppm of inhaled NO is an indication to initiate ECMO
d) Infants with PPHN requiring ECMO have an approximately 85% mortality rate
e) A serum blood glucose should be checked because hypoglycemia predisposes infants to PPHN
Answer
Answer e. Hypoglycemia predisposes to PPHN, and patients with unexplained hypoxemia should have glucose checked to rule this out. Mortality for patients with PPHN requiring ECMO is lower than other patient groups utilizing ECMO. Echocardiography will likely show bowing of the ventricular septum towards the left.
Notes
- This question originally printed in the Pediatric Anesthesiology Review Topics kindle book series, and appears courtesy of Naerthwyn Press, LLC.