SAQ 346 – Paediatrics – critically unwell neonate and duct-dependent lesions

Paediatrics – critically unwell neonate and duct-dependent lesions.

a. Preparation

• Allocate ED roles and notify inpatient/paediatric staff.
• Prepare a resuscitation bay.
• Prepare airway and vascular access equipment.
• Calculate and prepare antibiotics, dextrose, fluid, and adrenaline doses.
• Brief staff on priorities and arrange cover for the rest of the department.

b. Major aetiologies

• Sepsis.
• Congenital heart disease.
• Metabolic disturbance, for example sodium abnormality.
• Endocrine disturbance, for example adrenal insufficiency or hypoglycaemia.
• Non-accidental injury.
• Other possibilities include overdose/toxin, seizure, and gastrointestinal emergencies.

c. Signs of duct-dependent lesion

• Cyanosis or hypoxia, including failed hyperoxia response.
• Absent femoral pulses.
• Hepatomegaly.
• Murmur.

d. Lesion groups

e. Medication

• Prostaglandin E1 (alprostadil/Prostin).
• Infusion at 50 ng/kg/min, increasing to 100 ng/kg/min if needed.
• Important adverse effect: apnoea. Others include hypotension, hypoglycaemia, and transient hyperthermia.