Episode 196: The Critically Ill Infant

We discuss an approach to the critically ill infant.
Hosts:
Ellen Duncan, MD, PhD
Brian Gilberti, MD



https://media.blubrry.com/coreem/content.blubrry.com/coreem/The_Critically_Ill_Infant.mp3



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Tags: Pediatrics





Show Notes
The Critically Ill Infant: THE MISFITS
Trauma

* ‘T’ in the mnemonic stands for trauma, which includes both accidental and intentional causes.
* Considerations for Non-accidental Trauma:

* Stresses the importance of considering non-accidental trauma, especially given that it may not always present with obvious external signs.


* Anatomical Vulnerabilities:

* Highlights specific anatomical considerations for infants who suffer from trauma:

* Infants have proportionally larger heads, increasing their susceptibility to high cervical spine (c-spine) injuries.
* Their liver and spleen are less protected, making abdominal injuries potentially more severe.





Heart

* 5 T’s of Cyanotic Congenital Heart Disease: Introduces a mnemonic to help remember key right-sided ductal-dependent lesions:

* Truncus Arteriosus: Single vessel serving as both pulmonary and systemic outflow tract.
* Transposition of the Great Arteries: The pulmonary artery and aorta are switched, leading to improper circulation.
* Tricuspid Atresia: Absence of the tricuspid valve, leading to inadequate development of the right ventricle and pulmonary circulation issues.
* Tetralogy of Fallot: Comprises four defects—ventricular septal defect, pulmonary stenosis, right ventricular hypertrophy, and an overriding aorta.
* Total Anomalous Pulmonary Venous Connection (TAPVC): Pulmonary veins do not connect to the left atrium but rather to the right heart or veins, causing oxygen-rich blood to mix with oxygen-poor blood.


* Other Significant Conditions:

* Ebstein’s Anomaly: Malformation of the tricuspid valve affecting right-sided heart function.
* Pulmonary Atresia/Stenosis: Incomplete formation or narrowing of the pulmonary valve obstructs blood flow to the lungs.


* Left-sided Ductal-Dependent Lesions:

* Conditions such as aortic arch abnormalities (coarctation or interrupted arch), critical aortic stenosis, and hypoplastic left heart syndrome are highlighted. These generally present with less obvious cyanosis and more pallor.


* Diagnostic and Management Considerations:

* Routine prenatal ultrasounds detect most cases, but conditions like coarctation of the aorta and TAPVC might not be apparent until after birth when the ductus arteriosus closes.
* Emphasizes the importance of a thorough physical exam: checking for murmurs, assessing hepatosplenomegaly, feeling for femoral pulses, measuring pre- and post-ductal saturations,