Thanks to PEM fellow Brittany for today’s cases.

A 1 week old presents with cyanosis and sweating with feeds. No history of fever, preceding illness. O2 sat is 85%. Child is placed on 100% O2 but O2 sat does not improve.

What are some possible causes of these symptoms?


What is your goal O2 sat for these patients?


What is the treatment?


Underlying cyanotic congenital heart disease: congenital heart defect, coarctation of the aorta, severe aortic stenosis, VSD/ASD.

These are ductal dependent lesions.  The ductus arteriosus  normally closes in the first day of life, but will remain patent up to three weeks in these patients.

Goal O2 saturation?

Only 80-85%, hypoxia stimulates prostagladin release which keeps the ductus open.


exogenous prostaglandin drip, like Alprostadil (PGE1)

start at 0.05-0.1 mcg/kg/min IV initially, titrate to lowest dose where symptomatic response is maintained, usually 01-0.4 mcg/kg/min. Response should occur in ~5 minutes.

Notable side effects are apnea and fever (>10% of patients), so have the intubation box ready.


Adapted from EM: RAP May 2012

Pediatric Chest Pain with Ghazala Sharieff, MD