MedBugs: SAQ #141

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Case: Crashing neonate

A 6-day-old is brought to your ED, floppy and lethargic. The child was born at term by normal vaginal delivery. Birth weight 2900g. He was discharged on Day 2 of life and is being formula fed. He has had progressive lethargy and worsening feeding over 2-3 days. In the ED: Pale, RR 60, HR 170, poor cap refill, floppy, withdraws & cries with painful stimulus. Sepsis and congenital cardiac abnormalities are common causes of the “crashing neonate”.

1. List (5) OTHER differentials in (5) different categories (5 marks) 5 marks

2. Outline your initial empiric treatment steps for this child in the first hour. (5 marks) 5 marks

Based on your examination findings, you suspect a duct dependent abnormality like coarctation of the aorta.

3. Explain the clinical rationale of prostaglandin E1 infusions in this context. (2 marks) 2 marks

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Case: Crashing neonate

1. List (5) OTHER differentials in (5) different categories (5 marks) 5 marks

2. Outline your initial empiric treatment steps for this child in the first hour. (5 marks) 5 marks

3. Explain the clinical rationale of prostaglandin E1 infusions in this context. (2 marks) 2 marks

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