A 5-day-old neonate develops sudden cardiovascular collapse. On examination, femoral pulses are absent, BP is 90/60 in the right arm but unobtainable in the legs. The neonate had been discharged from the nursery at day 2. The MOST likely diagnosis and immediate treatment is:
- A Critical coarctation of the aorta — prostaglandin E1 infusion to maintain ductal patency ✓
- B Large VSD — surgical repair
- C Pulmonary atresia — balloon valvuloplasty
- D Complete transposition of the great arteries — balloon atrial septostomy
Correct answer: A. Critical coarctation of the aorta — prostaglandin E1 infusion to maintain ductal patency
Explanation
Critical coarctation of the aorta (ductal-dependent systemic circulation) presents with cardiovascular collapse when the ductus arteriosus closes at days 3–7 of life. The classic finding is absent/weak femoral pulses with upper limb hypertension and lower limb hypotension (radio-femoral delay). Immediate treatment is prostaglandin E1 (0.05–0.1 mcg/kg/min) to reopen the ductus arteriosus and restore systemic perfusion, followed by surgical repair or balloon dilation. TGA presents with cyanosis and an intact ductal-dependent pulmonary circulation.
Reference: Ghai Essential Pediatrics, 10th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.