Neonatal Blues: Cyanosis and Failure to Thrive in a Newborn

Abstract

Congenital heart disease is a spectrum of structural anatomic defects, and clinical manifestations arise from a combination of fixed anatomy and dynamic physiologic processes. We describe a newborn with acyanotic congenital heart disease who rapidly developed hypoxemia, cyanosis, respiratory distress, and failure to thrive. Less than 2 weeks after birth, an unusual constellation of cardiac anatomy (a large ventricular septal defect, double orifice mitral valve, and supramitral ring) cumulatively yielded cyanotic physiology. The acute clinical change prompted immediate anti-congestive therapy and urgent cardiothoracic surgery. This case is the first report of successful neonatal cardiac surgery for this cyanotic constellation of defects, which are independently classified as acyanotic structural defects. It is an important reminder that newborns with multiple intracardiac lesions may behave unpredictably throughout the neonatal transition period, and the cardiac differential diagnosis need not be strictly tied to the more common cyanotic anatomy (i.e., limited to one of the classic five Ts and single ventricle).

Int J Clin Pediatr. 2022;11(2):51-55
doi: https://doi.org/10.14740/ijcp486