Twenty Minutes After Delivery by Lower Segment Cesarean Section at 38

Twenty minutes after delivery by lower segment cesarean section at 38 weeks' gestation, a 4630-g (10-lb 3-oz) male newborn has respiratory distress. Apgar scores were 7 and 8 at 1 and 5 minutes, respectively. The newborn's temperature is 36.9°C (98.4°F) , pulse is 155/min; and respirations are 72/min. Pulse hree 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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