Zusammenfassung der Ressource
right to left shunts
- 2 types
- tetralogy of Fallot
- transposition of the great arteries
- presentation
- cyanosis
- blue, O2 sats <=94% and collapsed
- in 1st week of life
- hyperoxia (nitrogen wash out) test
- to help determine
presence of heart
disease in a
cyanosed neonate
- infant placed in 100% O2 (headbox or ventilator) for 10 mins
- if right radial arterial PaO2 from blood gas remains low after this
- i.e. <15kPa, 113 mmHg
- and lung disease and persistent pulmonary HTN of newborn (persistent fetal circulation) excluded
- diagnose cyanotic congential heart disease
- if PaO2 > 20 kPa
- infant does not have cyanotic heart disease
- blood gas must be done
- O2 sats not reliable in the range of values mentioned
- Mx
- 1. stabilise airway, breathing & circulation
- artificial ventilation if needed
- 2. start prostaglandin infusion (PGE, 5ng/kg/min)
- most infants w/ cyanotic heart disease presenting in 1st few days of life are duct dependent
- i.e. reduced mixing btw oxygenated
blood from lungs & deox blood from
body
- maintaining ductal
patency is vital for early
survival
- 3. observe for potential S/Es
- apnoea
- jitteriness
- seizures
- flushing
- vasodilatation
- hypotension