Infant Suffers Cardiovascular Collapse After Emergency Room Visit

Case Overview

Questions to the Neonatology expert and their responses

What is the appropriate pharmacotherapy for coarctation of the aorta?

If there is any concern in the initial evaluation for a critical coarctation of the aorta, or other ductal dependent cardiac anomaly, then prostaglandins should be initiated until cleared by a cardiologist or negative echo, in order to prevent this sort of unfortunate outcome.

When would a pediatric cardiology consult be pertinent?

A persistent heart murmur should warrant an echo and/or cardiology consult in this situation.

What is the clinical presentation of a newborn with coarctation of the aorta?

When a newborn presents with respiratory distress and hypoxia/cyanosis, it must be determined whether or not this is due to respiratory or cardiac disease. If it isn't clearly due to transient lung disease, as evidenced by chest xray/physical exam/etc., then a thorough evaluation (echocardiogram) of possible cardiac origin should be taken. Four-extremity blood pressure, which would suggest coarctation, should be done on all NICU admissions for respiratory disease.

About the expert

This qualified expert is an Assistant Professor of Pediatrics at amogn the nation's top medical schools and has been on faculty for the Division on Neonatology since 2001. He is the director of the Intermediate Level Nurseries and assistant director of the Special Infant Care High Risk Follow-up Clinic at his current institution. He has cared for many infants with conditions similar to that descibed in the case and is very familiar with the standard of care in diagnosing and treating infants with in utero or perinatal hypoxic events. He is an expert in caring for these babies in the neonatal period, and also knows the standard of care in diagnosing in utero and perinatal hypoxic events, and prescribing therapeutic interventions when motor deficits present outside the newborn period.