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Cardiac or respiratory cause of hypoxia in a newborn
  1. Martha McKenna1,
  2. Gemma Batchelor1,
  3. Bernadette O'Connor1,
  4. Michael McGowan1,
  5. Richard L Conn1,2
  1. 1 Ulster Hospital, Dundonald, UK
  2. 2 Centre for Medical Education, Belfast, UK
  1. Correspondence to Dr Richard L Conn, Centre for Medical Education, Queen's University Belfast, Belfast BT9 7BL, UK; r.conn{at}

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A term baby boy was delivered overnight by emergency caesarean section for pathological cardiotocography. An uncle died in childhood due to ‘a problem with the aorta’.

After initial cry, he required resuscitation including chest compressions. He was stabilised on nasal continuous positive airway pressure therapy (nCPAP). Oxygen saturations remained labile with a notable preductal and postductal gradient of 10% with brief preductal saturations of greater than 90%. Cardiovascular examination was normal. A chest X-ray was taken at 2 hours of life (figure 1).

Figure 1

Anteroposterior chest radiograph taken at two hours of life.

Question 1

‘Egg on a string sign’ suggests which congenital cardiac condition?

  1. Coarctation of the aorta

  2. Ebstein anomaly

  3. Tetralogy of Fallot

  4. Total anomalous pulmonary venous return

  5. Transposition of the great arteries

Question 2

What pathological finding is seen on this X-ray?

Question 3

What emergency treatment should be considered?

Question 4

Which …

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  • Twitter @richardlconn

  • Contributors MMcK and RLC wrote the submission, which was reviewed, edited and agreed on by the coauthors.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.