Important Considerations in the Management of Newborns with Cyanosis

Abstract

A term male infant is born via spontaneous vaginal delivery. The infant is breathing in room air with a heart rate of 150 beats/min, blood pressure of 64/30 mm Hg, and preductal and postductal saturations of 65% and 74%, respectively. After several minutes, the preductal saturation is 40% and the postductal saturation has decreased to 72%. The infant undergoes echocardiography and then a procedure (Video 1 and 2). What is this infant’s most likely lesion? Video 1. Click here to view the video. Video 2. Click here to view the video. 1. L-Transposition of the great arteries 2. D-Transposition of the great arteries with intact ventricular septum 3. D-Transposition of the great arteries with large ventricular septal defect 4. D-Transposition of the great arteries with pulmonary hypertension 5. D-Transposition of the great arteries with closed ductus arteriosus This infant has reversed differential cyanosis, which is consistent with transposition of the great arteries (TGA). If a patient with TGA has decreased mixing at the atrial level (as seen with lower preductal oxygen saturations), the clinician needs to be concerned about the size of the atrial communication. Once it is suspected that a balloon atrial septostomy may be necessary, it is critical to alert the cardiac catheterization team as early as possible because it may take time to prepare the personnel and equipment. As the catheterization team is being assembled, echocardiography needs to be performed quickly to confirm the diagnosis, assess the cardiac anatomy, and determine the potential sources for mixing of the circulations. Umbilical lines should be placed and prostaglandin started, but not at the expense of delaying balloon atrial septostomy. ### Prenatal TGA can be classified as L-TGA, which is also known as congenitally corrected TGA and is often associated with complete heart block (Fig 1), and D-TGA (Fig …