Often present in the first 1-2 weeks of life (children born prematurely tend to be at the upper end of the spectrum as they may have delayed closure of the ductus arteriosus)
May present with tachypnea, sudden onset of cyanosis or pallor (often worse with crying), diaphoresis with feeds, lethargy, or failure to thrive
Oxygen challenge - place baby on 100% 02 via NRB; 10% improvement in SpO2 (or 30mmHg increase in PaO2 on ABG) suggests a pulmonary issue; no or minimal change suggests a congenital heart defect
If congenital heart disease is suspected, start PGE-1 infusion at a rate of 0.05-0.1ug/kg/minute; improvement may be drastic and is usually seen within 15 minutes
Side effects of PGE-1 infusion include apnea, fever, hypotension, and seizures; have your code cart and intubation equipment ready to go prior to beginning infusion
