Consulting Child Specialist Neonatal Intensivist

Management
Ultimately Surgical Neonate with cyanosis: Prompt infusion of PGE1, corrective surgery within 2-4 mo of age 2Medical Tx: Aim: Acute relief of hypercyanotic episode Prevention of complication of R-L shunt R-

Management
Hypercyanotic episode:
Place over abdomen in knee-chest position or hold infant with kneelegs flexed on abdomen Oxygen: to q dyspnea & cyanosis (Not very helpful because minimal pulmonary blood flow) Protracted/Severe non-responding episode: IV Soda Bicarb nonfor metabolic acidosis Vasopressors: Phenylephrine 0.02 mg/kg iv or 0.1 mg/kg im or better by iv infusion 2-5 g/kg/min 2Any hypercyanotic episode : absolute indication for surgery. Ideally referral should precede spelling.

Management
Hypercyanotic episode:
Treat microcytic hypochromic anemia till PCV reaches 505055% If surgery is contraindicated, give oral propanolol 0.5-1 mg/kg/ 0.5dose 6 hrly to prevent/reduce frequency of paroxysmal dyspneic attacks Ensure adequate hydration during episode

Management
Long term medical therapy:
Oral iron for microcytic hypochromic anemia Prevent & treat dehydration promptly esp. in febrile illness & hot weather Cerebral, mesenteric, renal & pulmonary thrombosis (with severe polycythemia): esp. < 2 yrs Brain abscess & convulsions: > 2 yrs, surgical drainage + antibiotics. Insidious onset with low grade fever/behavioral change Thrombocytopenia Phlebotomy & replacement with FFP in extreme polycythemia, heparin has little role rather C.I. in hgic cerebral infarction

Management
Bacterial endocarditis CCF: rare; with pink or acyanotic TOF