Author: Aynsley Day / Editor: Sarah Edwards / Codes: CC6, NeoC3, SLO5 / Published: 22/11/2021

A 5-day-old neonate is brought to your Emergency Department (ED) by his worried parents.

He was born at term by normal delivery.  The pregnancy had been uneventful with routine antenatal care.  He had been discharged home the same day he was born once feeding had been established. 

Over the past 12-24 hours he has not been feeding well and has been breathing more quickly.  For the last 6 hours he has seemed sleepier.

The triage nurse is worried that he has poor colour and tone and asks you to assess him immediately.

On your assessment in resus:

  • A: Maintained
  • B: RR 70, sats 94% air (poor trace), mild-moderate increased work of breathing, no added sounds
  • C: HR 190, tachycardic but with normal heart sounds, BP 75/50 arms, unrecordable in legs, central capillary refill time 5 seconds, grey colour, cool peripheries, 1cm liver edge, absent femoral pulses
  • D: GCS 9, poor tone, capillary blood glucose 4.1
  • E: No rash, temp 35.9

A capillary gas shows he is acidotic with a pH of 6.90 with normal electrolytes and a lactate of 8.

You put out a paediatric emergency 2222 call. You gain proximal tibial intra-osseous access, give a 10ml/kg fluid bolus and antibiotics to cover for sepsis.  A portable chest radiograph looks relatively normal with some upper lobe diversion.  There is little response to the fluid bolus and you suspect congenital heart disease (CHD).

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