Tetraology of Fallot

[htrn]

I have never seen a kid so vigourous that was so blue. Two questions:

Is Tetralogy of Fallot something that should have be picked up on screening OB ultrasound?

We had this kid on 86% + Hood O2 prior to getting him shipped. If I remember correctly, with this disorder isn't it better to keep kiddos sats lower to preserve fetal circulation until surgery? Of course, we did not know what was wrong with him when we shipped him out - which is why I am a little upset with not having any hint about the problem prior to delivery.

Love to hear your responses - you folks have taught me an awful lot and I really do appreciate that.

[NotReady4PrimeTime, RN]

janfrn I have a question for you-since you are so knowledgeable. I had a term c/s baby who became blue, about 15 min of age, pre-ductal o2 sats were in low 80's and post-ductal sats low 50's. She pinked up after 2 mins of bagging with 100% o2 and then maintained under 50% fio2 oxy-hood. She was very active/alert the entire time. The difference in the pre-ductal and post-ductal sats was 20-30% difference for the next 2 hours with the pre-ductal being the higher value. Then it began to become the same and infant was able to be weaned off the o2. We never could figure this one out:nurse:

The most likely thing I can think of here is a slow-to-close foramen ovale. If you recall your fetal anatomy, the foramen ovale is an opening between the two atria that is part of fetal circulation. Normally it pretty much snaps shut once the paO2 rises beyond the fetal norm. The ductus arteriosus closes more slowly, partly because it's bigger, and both of them can reopen in the first hours to days of life if they haven't closed completely, due to a drop in paO2, a rise in pCO2 and acidosis. When the foramen ovale remains patent, the blood from the higer pressured left side shunts to the lower pressured right side, causing a drop in O2 in the mixed blood. So preductally I'd expect to see lower sats. Make sense?

Heather, you don't have to do the pre and post sats at the same time, you'll still see the same results if you do one now and the other in an hour. Another thing that might be important is that the preductal sats reflect cerebral oxygenation too. Now feet, they're a bit different because of their distance from the core, but there will likely still be a difference. Another phenomenon is diminished pulses and markedly lower sats in the lower limbs with coarctation or interuppted aortic arch.

I love this forum for the workout it gives my A&P!! It makes me really think about what I do every day and why I'm doing it. Right now we're having a run on Fontans that mirrors the run on Norwoods we had about three years ago and the run on Glenns we had two Christmases ago. Most of them do very poorly with very long stays... one little gaffer is on ECMO. He would be the one I waited for the whole day last week who came out of the OR 15 minutes before the end of my shift. My Spidey sense wasn't just tingling, let me tell ya!