A 30-Minute-Old Boy Is Evaluated in the Neonatal Intensive Care

A 30-minute-old boy is evaluated in the neonatal intensive care unit for cyanosis.  The patient's 1-minute Apgar score was 8, but he developed cyanosis a few minutes after delivery.  He was born by spontaneous vaginal delivery at 32 weeks gestation after his mother had preterm prelabor rupture of membranes and preterm labor.  The mother received a dose of glucocorticoids and penicillin prophylaxis for group B Streptococcus prior to delivery.  Birth weight was 1.7 kg (3 lb 12 oz) .  Temperature is 37 C (98.6 F) , blood pressure is 66/42 mm Hg, pulse is 160/min, and respirations are 70/min.  Pulse oximetry in the right upper extremity and left lower extremity is 65% on room air.  Oxygen is administered, and the oxygen saturation improves to 92%.  Cardiac examination shows a grade 1/6 systolic murmur at the left sternal border.  Pulmonary examination shows grunting, intercostal and subcostal retractions, nasal flaring, and shallow respirations.  Chest x-ray is shown in the exhibit.  Which of the following is the most likely diagnosis in this patient?

A) Coarctation of the aorta
B) D-transposition of the great arteries
C) Persistent pulmonary hypertension
D) Respiratory distress syndrome
E) Transient tachypnea of the newborn

Correct Answer:

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