An Unusual Cause of Cardiac Failure in a Newborn

Abstract

A late preterm neonate presents with irregularly irregular heart rate, tachycardia, and respiratory distress soon after birth. ### Prenatal and Birth Histories ### Presentation (Day 1) Immediately after birth, the neonate was noted to have tachypnea and tachycardia. The neonate was transferred to the neonatal intensive care unit and was given oxygen by head box with a 3-L/min flow and intravenous 10% dextrose at 60 mL/kg/d. Bedside electrocardiography revealed atrial flutter with absent P wave (Fig 1). Figure 1. Atrial flutter apparent on bedside electrocardiogram. Chest radiography revealed cardiomegaly. Bedside echocardiography revealed a right atrial mass that measured 27 × 27 mm along with multiple small masses along both sides of interventricular septum and left ventricular posterior wall (Fig 2). Figure 2. Two-dimensional echocardiogram showing a 27 × 27-mm mass in the right atrium. Multiple small masses are apparent on the interventricular septum. ### Vital Signs ### Physical Examination (Day 1)