A 1-Hour-Old Boy Is Evaluated in the Newborn Nursery for Feeding

question 279

Multiple Choice

A 1-hour-old boy is evaluated in the newborn nursery for feeding difficulty.  The patient was born at 40 weeks gestation to a 22-year-old primigravida via spontaneous vaginal delivery.  Apgars were 8 and 9 at 1 and 5 minutes, respectively.  The boy was placed on his mother's chest for skin-to-skin care and has been attempting to breastfeed.  He was able to latch and begin feeding but within 1 minute, his face developed a blue tinge.  The boy cried, and his color improved.  His mother tried repositioning the patient a few times, but his skin continued to turn blue shortly after feeding with return of normal color after crying.  Temperature is 37.2 C (99 F) , and pulse is 150/min.  Pulse oximetry is 97% and 96% on room air, measured from the right hand and left foot, respectively.  The palate appears intact.  Lung examination shows equal sounds bilaterally.  There are no murmurs or gallops.  Peripheral pulses are strong.  The abdomen is soft, and there is no organomegaly.  The skin appears pink.  Chest radiograph is normal.  Which of the following is the best next step in evaluation of this patient's symptoms?

• A)Draw blood cultures
• B)Measure blood methemoglobin level
• C)Obtain an echocardiogram
• D)Pass a catheter through the nares
• E)Perform ultrasound of the head

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Definitions:

Aggressive-Rejected

Refers to individuals, often children, who are not accepted by peers because of their hostile or confrontational behavior.

Disliked

The feeling of disfavor or aversion towards someone or something.

Popular

Well-liked or widely admired by many people, often used to describe trends, individuals, or concepts that have gained a lot of public approval.

Systematic Attacks

Coordinated and planned actions intended to cause damage or disorder to a system or community.