A Newborn Is Transferred to the Neonatal Intensive Care Unit

A newborn is transferred to the neonatal intensive care unit 4 hours after delivery due to cyanosis.  The infant was born via a spontaneous vaginal delivery at 41 weeks gestation to a 22-year-old gravida 2 para 2 woman.  The pregnancy and delivery were uncomplicated.  Three hours after delivery, circumoral cyanosis was noted after the infant was breastfed.  Pulse oximetry readings were 98% in the right hand and 83% in the left foot.  On physical examination, the patient has subcostal retractions and grunting.  Cardiac examination reveals a 2/6 systolic murmur at the left lower sternal border.  Femoral pulses are strong bilaterally.  Which of the following is the most likely cause of this infant's cyanosis?

A) Left-to-right shunt via atrial septal defect
B) Left-to-right shunt via patent ductus arteriosus
C) Left-to-right shunt via ventricular septal defect
D) Right-to-left shunt via atrial septal defect
E) Right-to-left shunt via patent ductus arteriosus
F) Right-to-left shunt via ventricular septal defect

Correct Answer:

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