Approach to cyanosis (newborn) Quiz: Ace Your Exams
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Six hours ago, a newborn girl was delivered via uncomplicated vaginal delivery at 37 weeks of estimated gestation age. She is cyanotic and is having difficulty feeding in the newborn nursery. The pregnancy was uncomplicated, and the mother had regular prenatal care. The rupture of membrane was six hours prior to delivery, group B streptococcus (GBS) was negative, and amniotic fluid was clear. APGAR scores were 6 and 8 at 1 and 5 minutes, respectively. Temperature is 37°C (98.6°F) and stable, pulse is 210/min, respirations are 55/min, blood pressure is 63/39 mmHg, and oxygen saturation is 85% at the right hand and 86% at the left foot. Physical exam shows no dysmorphic features but reveals cyanotic mucous membranes and extremities. There is mild nasal flaring, and intercostal retractions are seen. Cardiac exam reveals a single loud second heart sound and harsh systolic ejection murmur at the left sternal border. On pulmonary exam, air entry is equal bilaterally and normal breath sounds are heard throughout. The abdomen is soft without hepatosplenomegaly. Pulses are equal and symmetrical bilaterally. Chest X-ray is shown below. Which of the following is the best next step for confirming the diagnosis?
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