Approach to cyanosis (newborn) Quiz: Ace Your Exams
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A newborn boy is delivered at 36 weeks of gestation age via emergency vaginal delivery due to maternal bleeding. The newborn appears pale and cyanotic immediately after delivery. The pregnancy was uncomplicated, and the mother had regular prenatal checks. Rupture of membrane was at delivery, group B streptococcus (GBS) is negative, and amniotic fluid is clear. APGAR scores are 4 and 7 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 53/29 mmHg, and oxygen saturation is 91% on room air. Physical exam shows pale skin and cyanotic mucous membranes. There is no nasal flaring, and intercostal retractions are not seen. Cardiac exam reveals normal S1 and S2 without murmur. The lungs are clear with equal air entry bilaterally. The abdomen is soft without hepatosplenomegaly. Femoral pulses are weak bilaterally. Chest X-ray is normal. Labs are shown below. Which of the following is the most likely cause of this patient’s findings?
| Laboratory value | Results |
| Hemoglobin | 12 g/dL |
| Hematocrit | 39 % |
| Leukocytes | 15,200 /μL |
| Platelets | 150,000/μL |
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