An Abnormal Echocardiogram and Telemetry Tracing in a Late Preterm Infant
A neonate is admitted to the NICU for a late preterm birth at 34 6/7 weeks ’ gestation. The pregnancy was complicated by premature rupture of membranes and maternal intrapartum fever. The neonate’s initial course is unremarkable except for a requirement of supplemental oxygen by nasal cannula to maintain oxygen saturation above 94% and nasogastric feedings. On the 10th postnatal day, the neonate is noted to have episodic desaturations, with oxygen saturations decreasing to the low 80s. Physical examination findings are notable for a new grade 2/6 soft systolic heart murmur heard best at the apex. Clips of the infant ’s echocardiogram are shown inVideo 1 andVideo 2. The cardiologist is concerned about left ventricular systolic dysfunction with significant regional wall motion abnormalities. The study also shows that the neonate has moderate mitral regurgitation, a large patent ductus arteriosus, and left atrial enlargement. The coronary artery origins are noted to be normal.