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10-day-old infant presents with poor feeding for 3 days, today noted to be lethargic
PE: Limp, cyanotic, mottled V/S T 37, HR 80, RR 12, BP 52/38, O2 Sat 80% RA HEENT: open, soft AF, pupils 3->2 mm Heart: RRR, no murmur Lungs: no retractions, clear BS Abdomen: soft, nontender, no HSM Ext: cap refills > 5 seconds Neuro: decreased tone throughout
Clinical Features Depressed or altered mental status Lethargy Grunting respiration Head bobbing Increased work of breathing Bradypnea, apnea Poor muscle tone or floppy Skin changes: pallor, cyanosis, poor cap refills,
Right-to-Left Shunt Cyanosis, metabolic acidosis, decreased perfusion or CHF on CXR Transposition of great arteries Tetralogy of Fallot Truncus arteriosus Total anomalous venous return
Left-sided Obstructive Lesions Severe systemic hypoperfusion, decreased or absent pulses, metabolic acidosis, cardiomegaly with pulmonary congestion on CXR Hypoplastic left heart, Coarctation of aorta, interrupted aortic arch, AS
HSV cultures of vesicles, oropharynx, conjunctiva, urine, blood, stool or rectum, and CSF HSV PCR and LFTs - Mucocutaneous vesicles - Seizure - CSF pleocytosis with negative gram stain - Mother known to have HSV