jackryan said:
Not sure yet..All I know is temp was consistently high when charted. Same with BP and HR. Not sure what it means. Said that there is some other concerns but didn't elaborate. Have to wait for a full report.
I did not forget about your previous post and in the interim have done some reading on the subject. I find nothing that differs from this information:
Clinical Manifestations of Newborn with Critical Coarctation of the Aorta:
1) Asymptomatic until the ductus arteriosis begins to close (within the first fews days after
birth
2) After PDA closure:
1. Severe congestive heart failure, poor perfusion (cool
skin, pale extremities, etc.),
2. Tachypnea (fast breathing),
3. Metabolic acidosis,
4. Absent femoral pulses.
Diagnosis:
1) Auscultation--varies; nonspecific systolic murmur
2) CXR--varies
3) ECG--varies, normal or left and right ventricle hypertrophy
4) 2-D echocardiogram with Doppler study and color flow mapping identifies aortic arch
narrowing and associated lesions (bicuspid aortic valve, VSD, PDA)
5) MRA (like an MRI but is an angiogram)
6) Invasive studies (cardiac cath) usually not needed for initial diagnosis, may need
aortic angiography to identify collateral vessels before surgery.
Treatment of the Newborn (neonate):
1) Stabilize with prostaglandin E1 infusion to maintain cardiac output through the PDA;
treatment may cause fever and apnea (not breathing)
2) Intubation and ventilation as needed
3) Assessment of renal (kidneys), hepatic (liver), and neurologic function
4) Refer for surgical intervention (some coarctation recurs after surgery and requires 2nd
surgery)
Complications:
1) Hypertension
2) Congestive heart failure
3) Cerebral hemorrhage
4) Endocarditis
(This does not touch on problems associated with hypoplastic transverse aortic arch and mitral valve stenosis.)
Normal values for Newborns/Neonates:
Heart rate: Rate: 110-160 while awake, 80-110 while asleep;
Rhythm: common to find periods of decelertion followed by periods of
acceleration
BP: Newborns who weigh more than 3K (>7 pounds): 60-80 systolic, 35-55
diastolic; BP measurement is only recommended for infants in distress.
Immediately after birth: 70/45; 10 days after birth: 100/50. BP elevates with crying.
A blood pressure >20 mm Hg in the upper extremities than the BP in the
lower extremities strongly suggests coarctation of the aorta (remember BP
is not routinely measured in neonates who are not in distress.)
Respirations: Rate: 40-60 breaths per minute, influenced by sleep/wake status,
when last fed, drugs taken by mother, and room temperature.
May be as high as 80 breaths per minute or > when HR elevated.
Rhythm: may be shallow with irregular rhythm; symetrical and mainly
diaphragmatic; periodic breathing (5-15 seconds of apnea).
Cyanosis: Common finding: Acrocyanosis of distal extremities r/t transitional period
hemodynamic changes in the pattern of blood flow through
the newborn's heart and pulmonary circulation limiting
blood flow to peripheral vessels in the extremities.
Temp: 98.6 + or -, depending on many factors, including room temperature and
being held and immature thermo-regulation.
Back to your posted information:
During what period of time was the temperature elevated?
I remain convinced there is no viable claim of malpractice but I am going to point out one area that does concern me: If the OB/GYN knew there was a chance of a congental birth defect, why were the OB/GYN and pediatrician not aware of the need to place this neonate in the intermediate care nursery where nurses with specialized skills and additional education are available to look for the subtle changes and the more definitive changes that present in neonates with congental malformations? Why would the pediatrician discharge a high risk neonate without performing a complete physical examination, looking for subtle indications of malformation?
EC